Archive for the ‘Laser’ Category
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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If you are considering laser hair removal, you should know how many treatments you will truly need, and what type of a financial investment you will be making. I want to explain how many treatments you may need and why, so that you can make a more informed decision before you invest in laser hair removal.
I have people come in to our clinic after they have had a series of laser hair removal treatments at another clinic, and they are disappointed because they think it didn’t work. The problem is that many laser technicians will over promise and under deliver. The common misconception is that you will only need (let’s say 5) treatments. I don’t care what “they” tell you, this is almost never true! Don’t be surprised if you are told that “they” have the most effective laser on the planet and they can give you better results with only a few treatments. Maybe you will be told that you are perfect candidate, so you will need less than other people. If you buy this, I have a bridge to sell you. I do think that some technologies are more effective than others, however, even with the best technique and most effective equipment, you will still need several treatments. Even if you are the most ideal candidate in the entire world, you will still need several treatments.
Growth Cycle of Hair
Hair follicles go through a cycle of activity commonly refered to as the hair growth cycle. Each active hair follicle will continuously cycle through three phase of growth ( anagen, catagen and telogen). It is also important to understand that each hair follicle acts independently, so not all of the hair is in the same stage of growth at the same time. This is why it is necessary to have a series of laser hair removal treatments, scheduled at specific intervals.
Anagen Stage- Active Growing Stage
Catagen Stage – A Brief Transitional Stage
Telogen Stage – Resting Stage ( hair sheds at end of telogen stage)
With laser hair removal we are most concerned with hair in the anagen stage, because this is when the hair is at it’s maximum depth. The laser energy is absorbed by the melanin or water in the hair and we need to deliver the energy to the maximum depth of the follicle. This means that hair in the catagen or telogen stages of growth may singe and fall out with treatment, but they are not at thier maximum size or depth so they will likely grow back. So…. to reiterate, hair that is in the anagen stage of growth responds the best to laser hair removal.
The length of each cycle will depend on the region of the body, it will also vary from person-to-person and from time-to- time. Unfortunatly, in most areas the number of telogen hairs out number the amount of anagen hairs. For example the axillae (under arm) area is estimated to have about 70% of the hair in a telogen stage and the telogen stage in this area typically lasts for about 3 months. Again, this is not an exact science because there are several variables with the growth of hair and each idividual hair acts indepentaly. This means that the best you can hope for in this area is about 20% reduction per treatment and if by some sort of miracle your personal cycle of hair growth corasponds perfectly with your scheduled treatments you can complete your hair removal process with 5 treatments. However… you probably have a better chance of getting struck by lightining.
We all are born with a certain amount of hair follicals which do not increase with age, however the activity of the follicles do increase. We all have many, many potential hair follicles. Potential follicals are dormant hair follicles that are not active (currently producing a hair), but have the ability to produce a hair if stimulated by the appropriate hormone. Trust me when I tell you that you will likely see new hairs pop up in areas that you have never had them before. This is important to understand because laser hair removal only effects hair follicles that have a hair in the follicle at the time of treatment. Laser hair removal treatments can not prevent potential follicals from having the ability to produce a hair in the future. This is another reason that everyone needs to plan on having maintanance treatments after the intial series of treatments.
How Many Hair Removal Treatments Will I Need?
An initial series of treatments are necessary and occasional maintenance treatments are almost always needed after the initial series. For facial areas, you should expect to do an initial series of 12 treatments (once a month for a year). For body areas, you should expect to do an initial series of 8 treatments (scheduled about 6-8 weeks apart over a year).
There is no way to predict exactly how many maintenance treatments you will need. Some people need one every year or so, while others require several treatments for several years. This is due mostly to genetics and hormones, however other factors include technique, technology, and patient compliance. There are some things you can do to help improve your results. Keep your treatments on the appropriate schedule, avoid tanning, search for an experienced laser technician and a reputable clinic that is known to use better equipment. Do not wax, tweeze, or remove the hair from the follicle before or between treatments. If you have excessive hair growth, you should consult with your doctor to address any medial conditions that may contribute to hair growth.
Questions you should ask before you pay
Who will be performing your treatment?
Will you always see the same person or will you have somebody new each time? Do they have the appropriate certification and training, how long have they been doing laser hair removal and how long have they been at that specific clinic ?
Who is the medical director?
Are you having treatment in a medical practice or a med spa ? What are the credentials of the medical director ? Is it a Nurse, Dermatologist, Plastic Surgeon, Chiropractor, Dentist, Veterinarian? Is the medical director on site? How often are they in the office and are they available to see you if you experience a complication?
What is available for pain management?
Yes, laser hair removal hurts. The good news is that we can do things to help. Usually, we will apply a topical numbing cream before treatment, and in our clinic we use a proprietary formula that is extremely effective. I have a few other tricks that I will not share.
How much will it cost?
Many med spas have tricky packages or “plans”. Find out how many treatments are included in your package and how you are expected to pay. Do you need to pay for a full package all up front, or can you make payments? How much will additional treatments cost after your initial series? Is there a discount? Do you need to buy another package or can you pay as you go? If you are offered some sort of contract or membership, be careful, and be sure to read between the lines! You should also be warned that it is not uncommon for a med-spa to go out of business, and not tell clients or employees. You may show up one day with the doors locked, and, if you prepaid for a package, you can kiss your money good-bye.
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It is not surprising that the bikini area is one of the most common areas treated with laser hair removal. There are many advantages to having laser hair removal on the bikini area, but the most obvious is convenance. Lasers offer a more permanent solution to hair removal than waxing or shaving, so you don’t have the constant maintenance. Laser hair removal eliminates stubble, ingrown hairs and irritating red bumps. After laser hair removal, you no longer have to worry about shaving or waxing before you put on a swimsuit or skimpy little panties the area is always smooth.
Terms for popular bikini hair removal styles
Many of the terms used to describe the styles for bikini hair removal are used interchangeably, so always be sure to communicate exactly what you want with the person doing your bikini hair removal treatment.
Basic Hair is only removed from outside of the standard bikini panty line.
American (Modified Bikini) Hair is removed a little deeper inside bikini line than the basic.
FrenchHair is removed from the sides, leaving a thin strip on top. Hair is not removed from the labia, buttock or peri-anal area.
Brazilian Hair is removed from the sides, buttock and peri-anal area, leaving a small strip or triangle. Hair is not removed from the labia.
Playboy Hair is removed everywhere including labia, buttock and peri-anal area, leaving only a small strip on top.
Hollywood Everything is removed, leaving the area completely bare.
Bollywood Bejeweling the top of the bikini area, with crystals.
Bunny Tail Just above the anal area, between the cheeks
Don’t be shy
Many people feel embarrassed or awkward about having hair professionally removed from the bikini and anal area. As an Esthetician and Laser Technician, I can assure you that nobody should ever feel embarrassed about having a bikini wax or laser hair removal. This is our job, this is what we do all day. We do not care about the size, shape or color of anything. You do not have anything we have not seen before. ( Unless you have two vaginas) I have seen it all, piercings, tattoos, tampon strings and hemorrhoids. I have treated women, men and pre-op transsexuals. If you are someone that feels shy about having a bikini treatment, try to remind yourself that you are being treated by a professional.
What to expect during a treatment
Before you have a laser hair removal treatment you will have a consultation with your laser technician. During your consultation you will discuss what shape or style you would like, it is usually best to shave the area in the shape you like about two days before your treatment. Your laser technician may shave the area if there are any long hairs.
You will be taken in to a private room and asked to undress from the waist down. The technician will leave the room while you undress. You may wear panties or a swimsuit if you are only treating the hair that extends outside the pantie line. After undressing you will lay on the table and drape yourself with a sheet or towel. The laser technician will come back into the room and prep the area by shaving any hair that is to long and then applying a topical numbing cream. ( Numbing cream is optional) The numbing cream is usually left on for about thirty minutes before the treatment begins. After the numbing cream has had a chance to take effect your technician will come back in and begin treatment. Your technician will treat a section at a time, draping the other areas. The treatment itself takes about thirty minutes.
After your treatment the area may feel like a mild sun burn or razor burn. The area may also have little red bumps, this is follicular edema. Follicular edema is a normal response to the hair follicle heating up. The hair will begin to fall out over the next two weeks after treatment. It is important to keep the area cool immediately after your treatment.
How many treatments are needed?
Laser hair removal requires a series of treatments, a minimum of 8 treatment is needed on non-facial areas such as the bikini. Treatments are generally done about 6 weeks apart. Most people will require periodic maintenance treatments, after the initial series of 8 treatments. You may be told that you will only need 5 treatments, this is almost never true. There is not any special laser that has the ability to eliminate hair with fewer treatments.
Why do you need so many treatments?
When we do laser hair removal, we treat the entire area and most of the hair will fall out with each treatment. Unfortunately, only a small percentage of hair is permanently removed with each treatment. In most cases less than ten percent will be permanently removed with each treatment. The reason has to do with the growth cycle of hair. Hair goes through a growth cycle that includes anagen, catagen and telogen. Hair that is in the Anagen stage ( active growing phase) respond best to laser hair removal. Each hair follicle acts independently, so not all hair will be in the same cycle of growth at the same time. On the bikini area you may have only about thirty percent of hair follicles that are in the anagen stage at any given time, while up to 70% can be in a telogen stage for about twelve weeks. These growth cycles vary from person to person, and from time to time.
To complicate the hair removal process even further we all have “potential” follicles that have never produced hair, but have the potential to grow hair. The number of potential follicles far out number the anagen or telogen follicles. These potential hair follicles can be stimulated to produce a hair at any given time and laser hair removal can not prevent a potential follicle from having the ability to produce a hair.
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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 via a blog or even an email. 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.
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.
Laser peels, also known as a laser resurfacing, is the removal of the top layers of the skin via focused laser light energy. Some types of lasers may penetrate into deeper layers of skin to provide correction at a deeper level. Fully ablative laser resurfacing is used to remove moderately deep lines, scars, birthmarks and enlarged oil glands on the nose (rhinophyma). Laser resurfacing is usually performed using a Co2 (carbon dioxide) or Erbium laser, both lasers vaporize superficial, damaged skin cells. Laser resurfacing is an outpatient procedure that usually requires local anesthesia, and often done at the same time as surgical procedures.
CO2 is thought to give the best skin tightening, unfortunately it also creates the most downtime, pain and risks of adverse side effects. Newer versions of CO2 lasers can use short pulsed light energy (ultrapulsed) or continuous light beams that are delivered in a scanning pattern to very precisely remove thin layers of skin with minimal heat damage to the surrounding structures.
Erbium laser resurfacing creates minimal burning of surrounding tissue allowing for quicker recovery time than CO2 resurfacing procedure. Recovery time from the full coverage CO2 resurfacing is up to two weeks, compared to about one week with an Erbium laser. Erbium lasers cause minimal side effects, such as swelling, bruising and redness. Those with darker skin are usually a better candidate for erbium laser resurfacing compared to CO2.
The Sciton MicroLaser Peel is partial to full epidermal peel ( typically, 20 – 50 microns). The Sciton Erbium Yag laser is used for MicroLaser Peels and has the capability to treat at depths as minimal as 10 microns to as deep as 120 microns (full resurfacing). Microdermabrasion generally only removes the stratum corneum (10 microns). This is a versatile procedure because the settings can be adjusted to control the depth of the desired peel, while a computer guided scanner ensures maximum precision and treatment uniformity. Because this treatment ablates deeper into the epidermis, it is perfect step between microdermabrasion and full resurfacing.
Fractional Laser Resurfacing
Fractional resurfacing procedures have gained in popularity because their delivery systems dramatically reduce downtime compared to full coverage resurfacing. Fractional laser skin resurfacing treatments can utilize the same energy of an ablative resurfacing lasers, while providing the safety of non-ablative laser treatments. As a result, patients can undergo a corrective procedure, without the down -time. Fractional laser treatments target only a fraction of skin at a time, leaving the surrounding tissue intact, allowing the skin to heal faster. Fractional laser procedure are usually done in a series of treatments. Fraxel, ProFractioal and Ultrapulse (Active FX) are the most widely used fractional laser treatments.
ProFractional is a Fractional Erbium Ablative laser.
Active FX, Deep FX and Total FX
The UltraPulse fractional CO2 (10,600nm) laser system is capable of offering the full range of fractional resurfacing. The Active FX and Deep FX are both part of the UltraPulse Fractional laser, they are however separate handpieces that work differently. Patients are often confused by before and after photos, assuming they represent an Active FX treatment, when they may actually show results from a Deep FX or Total FX treatment.
DeepFX offers a small, deep spot microablative treatment
ActiveFX offers a large, superficial spot treatment.
Total FX is a treatment that combines both the DeepFX and ActiveFX.
Fraxel currently has four fractional systems.
Fraxel re:fine® treatment—for prevention and maintenance
This is the most gentle option, and is a cosmetic procedure that treats minor skin damage, with little to no down time.
Fraxel re:store® treatment—for mild to severe skin damage
The original and most popular Fraxel treatment, this treatment is used to resurface damaged skin and treat wrinkles around the eyes, acne scars, surgical scars, age spots/sunspots, melasma and Actinic Keratoses. There is minimal downtime , usually redness and some swelling. Most return to regular activities within a day or two.
1500nm Erbium laser
Fraxel Restore Dual uses both 1500nm Erbium laser and 1927 Thulium fiber laser
Fraxel re:pair® treatment— for the most severe skin damage
This is the most aggressive Fraxel treatment, it tightens skin, corrects severe damage, wrinkles, irregular texture, age spots/sunspots, sun-induced redness. There is increased downtime with this treatment, most return to routine activities after a week.
Fraxel Repair 10,600nm Co2 laser
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.
Bikini Hair Removal: Styles and Terms
Many of the terms used to describe the styles for bikini hair removal are used interchangeably, so always be sure to communicate exactly what you want with the person doing your bikini hair removal treatment.
Basic = Hair is only removed from outside of the standard bikini panty line.
American = ( modified) Hair is removed a little deeper inside bikini line than the basic.
French = Hair is removed from the sides, leaving a thin strip on top. Hair is not removed from the labia, buttock or peri-anal area.
Brazilian = Hair is removed from the sides, buttock and peri-anal area, leaving a small strip or triangle. Hair is not removed from the labia. (* Brazilian is often used to describe full hair removal including labia, buttock and peri-anal area.
Playboy = Hair is removed everywhere including labia, buttock and peri-anal area, leaving only a small strip on top. This sometimes is called a “landing strip”
Hollywood = Everything is removed, leaving the area completely bare.
Bollywood = bejeweling the top of the bikini area, with crystals.
Before you dare go bare, down there ………
Choose the “best” to do your bikini hair removal treatment.
Remember that the person that does your bikini hair removal treatment will know you almost as intimately as your gynecologist. You will be asked to get in some compromising positions, in order to thoroughly remove unwanted hair. You should feel comfortable with this person, and trust their professional abilities.
As providers we know that these types of treatments can be embarrassing, but I promise you we have seen just about everything and we are not judging. We are in the business of treating all shapes, sizes and ages ……. I have treated men, women, transexuals. I have treated clients with piercings, tattoos, hemorrhoids, surgery scars and tampons.
If waxing is the hair removal method you choose, look for someone that is experienced in “extreme waxing”. An esthetician that specializes in this type of waxing will be fast, thorough and their technique will reduce your discomfort. Be sure to ask your waxer in advance, how long the hair needs to be for it to be waxed, generally about 1/4 an inch is recommended. The length of time between waxing treatments will vary individually, typically 4-6 weeks. Those who are new to waxing, should expect to schedule treatments closer together. It will be more comfortable if there is not as much regrowth. Bringing us to another important tip. If you are getting waxed for the first time, it is not recommended to do it just before a special “occasion”
If you want a more permanent solution for hair removal, laser is the way to go. Laser hair removal can be a little uncomfortable, applying a topical anesthetic cream to the treated area 30-45 minutes prior to treatment make a world of difference. Laser hair removal does require a series of treatments, typically 8 treatments, scheduled 6 weeks apart. Laser hair removal is only effective on hair that is in the follicle at the time of treatment, so it can not prevent potential follicles from producing hair in the future. After an initial series, occasional treatments may be needed to treat any new hair that may have grown. Laser treatments can have complications, including burns and scars, which is why it is important that treatment are performed by an experienced laser technician.
Most of the lasers used for hair removal target melanin. We want the laser energy to be absorbed by the melanin in the hair, not the melanin in the skin, so it is important to not tan the treated area. Always tell your laser technician the amount of UV exposure there has been to the treated area. For laser hair removal, the hair should be a short stubble. It is best if you shave the area, to the desired shape, 3-5 days before your treatment. You do not want to wax or tweeze hair before treatment, because the laser targets the melanin in the hair, so the hair needs to be in the follicle at the time of treatment. Immediately after your first treatment, there is usually little red bumps called follicular edema, this is expected where the hair is coarse and usually resolves within 24 hours. The hair typically takes about 2 weeks to fall out after each treatment and regrowth begins about 6 weeks after each treatment. All or most of the hair will fall out with each treatment, but only a percentage will be permanently removed with each treatment. You can expect less and less hair to grow back after each treatment.
What to Ask During Your Consultation
During your consultation, ask if you will see the same Esthetician or Laser Technician for every treatment. It is also important to know how long your provider has been waxing or performing laser hair removal treatments. You also want to find out how long your provider has been at that location. Consider it a red flag, if a clinic has high employee turnover. If you are considering laser hair removal, ask if they offer topical anesthetic and are there discounted prices after your initial series. When considering laser hair removal, be sure to find out who the medical director is and if they are on site at that location. Finally, be sure you understand all of the risks invoked with treatment and be honest when discussing things like sun exposure, previous treatments and skin or health condition.
Be sure to let your provider know if you are using retinoid products (tretinoin) or on oral Accutane (Isotretinoin)