Posts Tagged ‘IPL’
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.
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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Rosacea is primarily a facial vascular disorder in which blood vessels are functionally and structurally abnormal. Currently rosacea can’t be cured, however it can be effectively treated and controlled. Rosacea is a progressive skin disorder, that should be treated when symptoms first begin. Treatment should be aimed at treating the underlying vascular issues associated with rosacea. Vascular Lasers and IPL treatments are extremely effective at treating existing redness and broken blood vessels. In addition to avoiding rosacea triggers, topical products can be used to prevent flushing and further damage that can accelerate the progression of the disorder.
Laser and IPL Therapy
Both Laser and IPL therapy are very effective at treating telangiectasia (broken blood vessels), generalized redness and flushing. IPL therapy can also be enhanced with Levulan to get the added benefit of treating acne, rosacea papules and pustuals.
Lasers that are absorbed well by hemoglobin are used to treat vascular concerns. The laser energy is absorbed by the blood vessel and creates heat within the vessel which damages the vessel wall and permenatly closes that vessel. The treated vessels are then absorbed by the body. Although there isn’t a cure for rosacea, studies show that laser treatment can permantly remove damaged facial blood vessels and with repeated treatment blood vessels will not always be created to replace the old vessel. Facial blood vessels treated with lasers are sometimes replaced with connective tissue. This is good news, because this will permently reduce the number of blood vessels in the face, near to the level of vessels found in healthy skin.
Lasers have a single wavelength that work at a very specific depth. So any idividual laser has it’s limitations. KTP 532 nm and Pulsed Dye: 577 -585nm lasers are well absorbed by hemoglobin and are very effective at treating superfical blood vessels in the face, while Nd:YAG 1064nm lasers are also well absorbed by hemoglobin, they are effective at treating vessels that are located deeper in the skin.
Intese Pulsed Light (IPL)
IPL skin treatments are known by many names including Fotofacial, Photofacial, Photoderm and Photo rejuvenation. Intense Pulsed Light (IPL) differs from lasers because IPL uses a wide spectrum of wavelengths at the same time (for example: 500nm — 1200nm) that can target any chromophore in that range, while lasers have a single wavelength. You can think of the laser like a sniper that can precisely hit a single target with one shot, and IPL is like a grenade that hits several targets at once. IPL uses special cut-off filters that can be selected to target chromophors in a certain range within the skin. When treating rosacea or any vascular concern, the intended target is hemoglobin. The advantage IPL treatments have over laser treatments is that IPL can target vessels at different depths.
Combined Laser and IPL Therapy
Best results are achieved when you combine IPL and Laser treatments. IPL and Laser treatments can be done independently, however combining technologies at the same treatment time will provide a better result. This type of treatment is fairly aggressive and should only be done by someone that is very experienced in combining these technologies.
Oral and Topical Products
Topical Metronidazole Gel
Metronidazole is topical agent used to treat rosacea, available only by prescription. The primary action of Metronidazole is anti-inflamatory. Metronidazole is effective at reducing papules and pustules and has a fairly minimal effect at reducing inflammation. Unfortunately, it isn’t effective for treating broken blood vessels or flushing.
Antibiotics have long been used to treat rosacea, however they work primarily through their anti-inflammatory properties rather than antibacterial. Antibiotics are effective at reducing papules, pustules, and inflammation. The limitation with antibiotics is that they are not effective at treating telangiectasia or flushing.
Antihistamines are effective at reducing facial inflammation, swelling and burning associated with rosacea. Histamine contributes to swelling, itching and burning. Histamine has also been shown to play a role in inflammation and redness.
Sunblock with Zinc Oxide
UV rays can penetrate the skin and activate sensory nerves that release potent vasodilators, as well as creating heat in the skin causing facial flushing. Zinc oxide reflects both UVA and UVB rays, blocking out heat from the sun. Topical zinc oxide also has significant healing properties when applied to damaged skin and has been shown to decrease inflammation in both the epidermis and dermis.
Dimethicone is a silicone based ingredient with moisturizing ability. Dimethicone is also a protective ingredient that has been shown to reduce flushing caused by skin irritants.
Free radicals have been shown to cause structural damage to vascular walls and many free radicals are potent blood vessel dilators. Dietary and topical antioxidants help to block the damaging effects of free radicals.
Studies show that vitamin C can protect blood vessel walls from free radical damage and reverse existing vascular damage. People with rosacea should get plenty of vitamin-C in their diet, and may want to consider a vitamin-C supplement. In addition to being a great antioxidant, topical vitamin-C has anti-inflammatory qualities.
*This post is intended for informational purposes only.
Radio frequency is not the same as laser, however it is often used in conjunction with laser treatments in a clinical setting. Radio frequency (RF) usually refers to oscillations in electrical circuits. Aesthetic treatments use non-ablative (RF) energy in short intense pulses that oscillate through the skin to heat targeted tissue. Radio frequency (RF) is often used to tighten the skin. The (RF) energy penetrates the skin and stimulates the contraction of collagen and the production of new collagen for skin tightening.
[ Read more about Laser technology ]
Radio frequency devices use a variety of delivery systems and penatrate to varying depths. Radio frequency can be monopolar or bipolar. Bipolar devices are often combined with other types of technology such as infrared light.
Monopolar vs Bipolar
For the purpose of aesthetic treatments Monopolar radiofrequency is delivered by applying a single electrode to the treated area and an opposing electrode that is relatively far removed so that the current goes deeply through the body. Unipolar (RF) penetrates deeper and more intensely than bipolar( RF). Thermage uses monopolar radiofrequency (RF) energy to tighten and contour skin.
For the purpose of aesthetic treatments bipolar radiofrequency is delivered by applying two closely positioned electrodes to the treated area. The electric current travels from one electrode through the tissue and back up to the other electrode, the current that goes between the electrodes is small and shallow. As a result, the tissue in the treated area is heated less deeply and less intensely than monopolar (RF). In aesthetic treatments bipolar RF is usually combined with light or energy based sources, including lasers, intense pulsed light, infrared light, or vacuum assisted. Infrared light heats the tissue down to the deep dermis and acts to “pre-heat” tissue, for improved (RF) penatration.
Bipolar Radiofrequency used with Laser and IPL
Unlike laser and Intense Pulsed Light (IPL) energy, radio frequency is not absorbed by a specific chromophore. When RF is combined with other energy sources such as lasers and IPL, the laser or IPL energy will be absorbed by the targeted chromophore (melanin or hemoglobin), resulting in an increased temperature in the target areas. The increases in tempeture lowers the tissue impedance to those areas and the RF energy will stream preferentially to the warmer areas with lowered impedance. Elōs is the first and only technology that simultaneously harnesses the power of bi-polar radio frequency (RF) and optical energy.
Bipolar Radiofrequency(RF) used with Suction
Bipolar radiofrequency can also be combined with negative pressure ( suction), to help improve and control the absorption of the RF energy. The tissue is suctioned into the hand-piece and the RF energy passes through. The Aluma uses a vacuum-assisted and bipolar radio-frequency (RF) handpiece for skin tightening methods.
VelaShape uses a combination of Infrared light, bi-polar radio frequency (RF) and negative pressure (suction) to heat deep adipose (fat) tissue. Infrared light, tissue mobilization, and suction, all work synergistically with RF to reduce cellulite.
Intense Pulsed Light (IPL) is used in photo-rejuvenation for the skin and hair removal treatments. Broad Band Light (BBL) is essentially the same thing as IPL and is used in the same way. Intense Pulsed Light (IPL) is not actually a laser. IPL emits a non coherent, broad spectrum light, rather than a monochromatic single wavelength like a laser. Basically lasers have one wavelength ( for example: 800nm) with a very specific target, and IPL uses a wide spectrum of wavelengths at the same time (for example: 500nm — 1200nm) that can target any chromophore in that range. You can think of the laser like a sniper that can precisely hit a single target with one shot, and IPL is like a grenade that hits several targets at once.
IPL uses special filters that block unwanted wavelengths. The filters can be changed to “cut off” the shorter wavelengths. The appropriate filter will depend on the depth of the intended target.
The cut off for the wavelength at the deeper end is predetermined, but can vary with each devise.
For example: Lumenis One has a wavelength of 515 – 1200nm,
and has 7 filters: 515, 560, 590,615, 640,695, and 755.
The 515 filter would block out wavelengths above and below 515nm – 1200nm, while the 560 filter would block out wavelengths above and below 560 -1200nm. The deeper wavelength, in this case 1200nm remains the same, while the “cut-off” filter can be changed to block out specific shorter wavelengths.
Each devises may use different wavelengths.
Sciton BBl: 420 -1400nm
Lumenis One: 515-1200nm
iPulse 1200: 530 – 1200nm
LimeLight: 520 – 1100nm
Cynergy XPL: 560 -950nm
IPL is well absorbed by chromophores that have color such as melanin, hemoglobin. The concentration of a specific chromophore peaks at different depths in the skin. The filter used in treatment is decided based on the depth of a desired target and the color of skin. A deeper cut off filter would be used for hair removal, while a shallow filter would be used when treating vascular issues such as rosacea. It is important to remember that IPL targets color in the skin, so tanning must be avoided before treatment. Patients with darker skin should seek treatment from someone experienced in treating their skin type, to avoid complications. IPL treatments can provide beautiful results, but can also cause serious burns. It is the patients responsibility to choose an experienced professional, be honest about sun exposure and follow all pre and post treatment instructions.
There are many variables involved in aesthetic lasers, including the active laser medium, wavelength, and targeted chromophore. Aesthetic lasers can be ablative, non-ablative or fractional. There are also other (non-laser) technology based treatments used in aesthetics such as Intense Pulsed Light (IPL) and Radio Frequency (RF).
The term “laser” originated as an acronym for Light Amplification by Stimulated Emission of Radiation. A laser generates a beam of very intense light. The light emitted by a laser is monochromatic, coherent and collimated.
Monochromatic – the light is of a single wavelength
Coherent - the light beam waves are in the same phase
Collimated - the light beams travel in parallel, all are parallel to each other.
Active Laser Medium Types
The lasing medium is the source of optical gain within a laser. The Active Lasers Medium can be a solid crystal, liquid dye, gas, or semiconductors.
Carbon dioxide (Co2) are gas lasers that are commonly used in aesthetic treatments.
Solid State Lasers
Generally, the active medium of a solid-state laser consists of a glass or crystalline material.
Solid state lasers include Ruby, Aexandrite and Erbium.
Semiconductor-based lasers are also in the solid state, but are considered as a separate class. Diode is a semiconductor based laser used in aesthetic treatments.
A dye laser is a laser which uses an organic dye as the lasing medium. A dye can usually be used for a much wider range of wavelengths which makes them suitable pulsed lasers. Pulsed Dye Lasers are used in aesthetic treatment.
Electromagnetic spectrum is the range of all possible wavelengths and frequencies. Wavelength is the distance over which the wave’s shape repeats ( peak to peak).Wavelenghths are measured in micrometers (microns) and nanometers (nm) Frequency is the number of oscillations per second, measured in hertz.
Energy is the amount of joules (J/cm) delivered. A laser technician adjusts the energy of each treatment, based on factors such as skin type and condition. The laser technician can also control other factors such as spot size and the length and duration of the pulse.
Lasers used in aesthetic treatments target a specific chromophore generally melanin, hemoglobin or water in the tissue. The targeted chromophore is determined by the wavelength. The concentration of a specific chromophore peaks at different depths in the skin. For example hemoglobin in the blood is best absorbed at a shallow wavelength and water is best absorbed at deep wavelengths. Melanin is best absorbed somewhere in the middle (500nm-1064nm), the exact depth can vary, depending on the desired target. For example if you are targeting pigment in the hair follicle a deeper wavelength (640nm-1064nm) would be used, however most lasers used for hair removal are Diodes (800nm-900nm).
Melanin and hemoglobin in blood vessels have color that absorbs the light emitted by specific lasers. Lasers that target color are usually used for hair removal, treating vascular issues such as rosacea and broken blood vessels, and skin discolorations such as freckels. Tanning is contraindicated with laser treatments that target color, tan skin will absorb more heat, increasing the probability of a burn. Tanning can also interfer with the desired results of treatment, because there is less contrast between the intended target and the surrounding tissue. Lasers that are used for hair removal target the color in the hair, so grey or blond hair will not respond well. (There are some lasers that claim to treat grey or light hair).
Water constitutes 80% or more of soft tissue, so lasers that target water are generly used for resurfacing. Lasers with deep wavelenghts such as Co2 or erbium lasers are strongly absorbed by water. The Smoothbeam laser is a 1450nm diode laser that targets water in the skin and is used to treat acne by shrinking the oil gland.
Argon 488 and 515 nm, is a gas laser that emits a blue green light which is strongly absorbed by both hemoglobin and water,used for photocoagulation. Argon lasers are rarely used for aesthetic or dermatologic treatments.
KTP 532 nm, a brilliant green light well absorbed by hemoglobin and melanin used photoablation and photocoagulation. The Iredex DioLite 532 nm KTP that is Diode Pumped, it is used to treat vascular lesions and hyperpigmentation.
Pulsed Dye: 577 -585nm, a yellow light that is well absorbed by hemoglobin in blood. Pulsed Dye Lasers (PDL) are especially useful for the treatment of vascular lesions, including spider veins, strawberry birthmarks and port wine stains.
Ruby 694 nm, uses a synthetic ruby crystal that emits red light that is strongly absorbed by blue and black pigment, and by melanin in skin and hair.
Ruby lasers are used for laser hair removal, tattoo removal and treating pigmented lesions including freckles, liver spots.
Alexandrite Laser 755nm, emits a deep red light and is absorbed by melanin. Alexandrite permits deeper penetration into skin than the ruby, and is used for Laser Hair Reduction.
Diode 800-900nm, emit near-infrared light. Diodes in the 800-900 nm range are absorbed by melanin and used for laser hair removal. The Smoothbeam uses a diode with a 1450nm, it targets water in the skin and is used to treat acne and build collagen.
Nd:YAG 1064nm, laser emits a near infrared beam that can be absorbed by all tissue chromophores, however it is strongly absorbed by hemoglobin. Nd:YAG lasers are used for photocoagulation and photoablation, commonly used to treat broken blood vessels.
Er:YAG 2940nm, emits a mid-infrared beam which has an absorption peak for water. Its used is to ablate tissue for cosmetic laser resurfacing. Also known as Erbium.
CO2 10,600nm, is a gas laser emitting a mid infrared beam which is strongly absorbed by water. Co2 lasers are capable of cutting or vaporizing tissue, and are used for deep laser resurfacing.
Ablative, Non-ablative an Fractional
Non-ablative lasers heat the layers of skin beneath the surface without removing the epidermis (top layer of skin).
Ablative procedures remove the epidermis. Carbon dioxide and Erbium lasers are ablative lasers used in aesthetic treatments. Ablative laser treatments are used for resurfacing, and leave skin raw.
Fractional lasers can be ablative or non-ablative treatments, and target only a fraction of skin at a time, leaving the surrounding tissue intact.
[ Read more on Fractional lasers ]
Some of the lasers used in aesthetic treatments:
Iredex DioLite – 532 nm KTP Diode Pumped – Non-Ablative
Candela Vbeam – 595nm Pulsed dye laser (PDL) – Non-Ablative
Candela GentleLASE – 755 nm Alexandrite – Non-Ablative
Lumenis LightSheer – 800nm Diode – Non-Ablative
Syneron eLaser / Comet – 810nm diode laser ( with RF) – Non-Ablative
Syneron Matrix IR – 915nm diode (with RF )- Non-Ablative/Fractional
Sciton Profile – Nd:YAG 1064 nm – Non-Ablative
Lumenis Multi-Spot – 1064 Nd:YAG – Non-Ablative
Candela GentleYAG – 1064nm Nd:YAG – Non-Ablative
Fraxel re:fine – 1410nm Erbium – Non-Ablative/Fractional
Cynosure Affirm – Nd:Yag 1440nm – Non-Ablative/Fractional
Candela Smoothbeam – 1450 nm diode laser – Non-Ablative
Fraxel re:store – 1500nm Erbium laser – Non-Ablative/ Fractional
Sciton Profile -2940nm Er:YAG – Ablative /(additional attachment to Profile base)
Sciton ProFractional – 2940 Er:YAG – Ablative/Fractional
Lumenis UltraPulse – 10,600nm Co2 – Ablative/ Fractional
Fraxel re:pair – 10,600nm Co2 laser – Ablative/ Fractional
Sometimes a little information can be a dangerous thing.
This is intended to help provide some very basic information of cosmetic / aesthetic lasers. There are many factors involved with laser aesthetic treatments and not everything can be included in this post. Aesthetic laser treatments can be complicated and should only be performed by a qualified and experienced technician.
There are many people that have embraced their freckles and love them, while others would prefer spotless skin.
Freckles are clusters of concentrated melanin, ranging in color from red, tan and brown. Some people have a genetic tendency to develop freckles, however sun exposure is the main cause of freckles. Freckles generally appear on sun-exposed areas, and will appear darker or more prominent after sun exposure. Ephelides is a freckle which is flat, light brown or red, and fades when protected from UV light. Ephelides are more common in those with light complexions. Liver spots (also known as sun spots and Lentigines) are freckles that develop after years of sun exposure, and are more prominent with age.
If You Want To Remove Freckles
The best way to remove freckles is to have a series of photofacial treatments, combined with bleaching creams containing 4% hydroquinone and tretinoin (Retin-A). A good UVA/UVB sunblock is also recommended, because UV exposure will make freckles more prominent.
Photafacial (Fotofacial) uses IPL (Intense Pulse Light) to treat skin discoloration, redness and broken capillaries. There generally isn’t any down time associated with IPL treatments, however pigmented spots will appear darker temporarily. After a photofacial any freckles or pigmented lesions will darken up and flake off. It can take up to two weeks for spots to flake off. The number of treatments needed will vary depending on the skin condition.
If You Like Your Freckles
If you are not concerned with removing freckles you can use lightening and brightening products. These products brighten the skin without removing freckles. Freckles will fade slightly, but will not go away.
OBAGI C-RX System
If you love your freckles, you may want to skip the Therapy Night Cream from this system. The Therapy Night cream has a 4% hydroquinone, which will further fade freckles and pigmentation. The Clarifying Serum also has a 4% hydroquinone, however this C- serum is only used in the morning and is not enough to eliminate freckles. The Clarifying Serum is great for anyone that wants brighten their skin tone, and still keep their freckles.
iS Clinical White Lightening Complex
Brightens and lightens skin with beneficial moisturizing properties. Utilizing an innovative blend of proprietary lightening ingredients and pharmaceutical-grade botanicals, this high performance formula exfoliates, reduces inflammation, and provides strong antioxidant protection.
White Lightening Complex will brighten the skin, and freckles will fade, but not go away completely.
To prevent freckles, you need to use a good sunblock. I recommend a UVA/ UVB sunblock with an SPF 30 or higher. I also recommend sunblocks with Zinc, because it is a broad band physical block. SPF only measure UVB protection, and even if a product is labeled to have UVA protection, it may not protect from the full UVA spectrum. Topical Vitamin C ( L- ascorbic acid) can also help prevent sun damage because it neutralizes UV radiation.
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 laser center based on their social media following or 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, in fact 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 worked with this laser or device?
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.