Posts Tagged ‘Laser Hair Removal’
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.
Throughout my career in medical aesthetics, Pseudofolliculitis and ingrown hair has been a common concern. Often times it’s men who mistake the condition for acne, other times it’s someone who has had an infection and a doctor recommended they get laser hair removal. The bad news is, that it can be more serious than you might think. The good news is, it can be treated!
What is Pseudofolliculitis?
Pseudofolliculitis commonly known as “razor bumps” or “ingrown hair” is an inflammatory condition in the skin and hair follicle caused by shaving, waxing and ingrown hairs. Pseudofolliculitis can occur anywhere on the body hair grows, however it most commonly occurs on a mans beard and for women on the bikini and underarm area. It tends to be more common in those with curly or coarse hair.
There are two types of Pseudofolliculitis, extrafollicular and transfollicular. Extrafollicular pseudofolliculitis or “razor bumps” occur when curly hair grows back into a hair follicle. Transfollicular pseudofolliculitis or “ingrown hairs” occur when the hair never leaves the follicle, this can happen if the hair grows at an angle. The hair keratin causes inflammation in the skin, usually seen as pustules that look similar to acne.
Concerns and complications associated with Pseudofolliculitis?
Pseudofolliculitis can be painful, embarrassing but more concerning is that it can lead to scars, secondary infection or become abscessed. You may not think that an ingrown hair is a big deal, but it has been associated with serious secondary infections such as MRSA. When there is damage to the skin, it becomes more susceptible to bacteria such as Staphylococcus. It is not unusual for an ingrown hair to become infected with “staph” or become abscessed. In extreme cases, if left untreated staph can lead to a very serious blood infection known as sepsis. These infections can spread and be contagious. If you suspect an infection, you need to seek immediate medical attention.
Laser hair removal remains the best treatment option for Pseudofolliculitis. A series of treatments will be needed, generally spaced 4-6 weeks apart. Another option is to quit shaving, waxing or tweezing and let the hair grow, but if that doesn’t work for you there are some things you can try. When shaving, start with cleansing the area with an exfoliating cleanser that has glycolic acid or some type of an AHA. I also recommend the Clarisonic cleansing brush, which will help to lift the hair. Before you shave place a steamed towel over the area, being careful not to burn your self. For sanitary reasons, I prefer a new razor. Avoid shaving too close, do not stretch the skin or shave against the direction of growth. If you have pustules, you may also be prescribed a topical antibiotic.
Chemical peels and skin care products that contain chemical exfoliant can help with skin discolorations and help to prevent hair from becoming ingrown. - ” the reducing properties of glycolic acid may reduce sulfhydryl bonds in the hair shaft, resulting in straighter hair growth, and thereby may potentially reduce the chance for re-entry of the hair shaft into the epidermis. Salicylic acid peels offer exfoliation and lightening in cases complicated by PIH. Reduced numbers of PFB lesions have been observed with both glycolic acid and salicylic acid peels.” Expert Rev Dermatol. 2009;4(6):595 Dermatologic Conditions in Men of African Ancestry by Marcelyn K Coley, Andrew F Alexis
Laser hair removal for skin of color, is challenging, but possible. If you have dark skin, be sure to find a laser technician that is also a skin specialist and has experience treating your skin type. Your specialist may recommend preconditioning the area prior to having laser treatment, it is important to comply with all instructions. We make these recommendations to prevent you from getting a burn. They may also suggest doing a test spot first to see how you respond to the laser treatment.
Treating the scars
Pigmented scars are the most common and can be treated consecutively with laser hair removal treatments. Pigmented scars can usually be treated with prescription strength skin care products, and chemical peels. Depressed scars require a deep treatment such as micro-needling, fractional laser resurfacing or dermabrasion. It is best to treat depressed or raised scars when the condition is well controlled. Keloid scars are very complicated and need to be diagnosed and treated by a dermatologist. I want to specify that keloid scars need to be diagnosed by a dermatologist, because raised scars are sometimes confused with keloid scars.
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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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Whats Trending Now?
Plastic surgery and cosmetic procedures have been a hot topic lately. Why? Because the cosmetic industry is boosting and is predicted to continue to growing as the economy improves. It is expected that Plastic Surgery and non-surgical cosmetic procedures will soon exceed pre-recession levels. The industry peaked in 2004 and saw a big decline in 2009. According to the ASAPS, Plastic Surgery procedures grew by almost 9% in 2010.
I am not sure if the increase in plastic surgery is a sign of an improved economy or not. I will say that I have seen more clients coming in because they want to stay competitive in the work force, especially in industries such as technology, that attract a younger generation of workers. People that are in sales or work with the public feel that their appearance has an impact on their income or ability to obtain a job. I have also seen an increase new clients, that want to improve their appearance before starting a new job. They are taking advantage of the time away from work to recover from surgery.
Top Procedures in 2010
2010-Top Surgical Procedures
#1 Breast augmentation (38.0% saline implants & 62.0% silicone implants)
#3 Eyelid surgery
#4 Abdominoplasty (Tummy Tuck)
#5 Breast reduction
#6 Rhinoplasty (nose reshaping)
#8 Breast Lift
#9 Autologous fat ( Fat transfer)
#10 Forehead lift
There were 1,622,290 total surgical procedures done in 2010.
2010-Top Non-surgical Procedures
#1 Botulinum toxin type a ( Botox & Dysport)
#2 Hyaluronic acid (including Hylaform, Juvederm, Perlane/Restylane)
#3 Laser hair removal
#4 Laser skin resurfacing (36.0% ablative & 64.0%nonablative)
#5 Chemical peel .
#8 IPL treatments ( aka..photofacial, fotofacial, photorejuvenation,)
#9 Non-invasive skin tightening
#10 Calcium hydroxylapatite (Radiesse)
There were 9,336,814 total non-surgical procedures done in 2010.
Men vs Women: Top Surgical Procedures
#1 Breast augmentation
#3 Breast reduction
#5 Eyelid surgery
#3 Eyelid surgery
#4 Breast reduction to treat enlarged male breast
#5 Cosmetic ear surgery.
The ASAPS survey is based on procedures performed by the surgeon, and may not include all of the nonsurgical procedures performed in the office by other staff such as physician assistants, nurses, laser technicians and estheticians .
Radio frequency is not the same as laser, however it is often used in conjunction with laser treatments in a clinical setting. Radio frequency (RF) usually refers to oscillations in electrical circuits. Aesthetic treatments use non-ablative (RF) energy in short intense pulses that oscillate through the skin to heat targeted tissue. Radio frequency (RF) is often used to tighten the skin. The (RF) energy penetrates the skin and stimulates the contraction of collagen and the production of new collagen for skin tightening.
[ Read more about Laser technology ]
Radio frequency devices use a variety of delivery systems and penatrate to varying depths. Radio frequency can be monopolar or bipolar. Bipolar devices are often combined with other types of technology such as infrared light.
Monopolar vs Bipolar
For the purpose of aesthetic treatments Monopolar radiofrequency is delivered by applying a single electrode to the treated area and an opposing electrode that is relatively far removed so that the current goes deeply through the body. Unipolar (RF) penetrates deeper and more intensely than bipolar( RF). Thermage uses monopolar radiofrequency (RF) energy to tighten and contour skin.
For the purpose of aesthetic treatments bipolar radiofrequency is delivered by applying two closely positioned electrodes to the treated area. The electric current travels from one electrode through the tissue and back up to the other electrode, the current that goes between the electrodes is small and shallow. As a result, the tissue in the treated area is heated less deeply and less intensely than monopolar (RF). In aesthetic treatments bipolar RF is usually combined with light or energy based sources, including lasers, intense pulsed light, infrared light, or vacuum assisted. Infrared light heats the tissue down to the deep dermis and acts to “pre-heat” tissue, for improved (RF) penatration.
Bipolar Radiofrequency used with Laser and IPL
Unlike laser and Intense Pulsed Light (IPL) energy, radio frequency is not absorbed by a specific chromophore. When RF is combined with other energy sources such as lasers and IPL, the laser or IPL energy will be absorbed by the targeted chromophore (melanin or hemoglobin), resulting in an increased temperature in the target areas. The increases in tempeture lowers the tissue impedance to those areas and the RF energy will stream preferentially to the warmer areas with lowered impedance. Elōs is the first and only technology that simultaneously harnesses the power of bi-polar radio frequency (RF) and optical energy.
Bipolar Radiofrequency(RF) used with Suction
Bipolar radiofrequency can also be combined with negative pressure ( suction), to help improve and control the absorption of the RF energy. The tissue is suctioned into the hand-piece and the RF energy passes through. The Aluma uses a vacuum-assisted and bipolar radio-frequency (RF) handpiece for skin tightening methods.
VelaShape uses a combination of Infrared light, bi-polar radio frequency (RF) and negative pressure (suction) to heat deep adipose (fat) tissue. Infrared light, tissue mobilization, and suction, all work synergistically with RF to reduce cellulite.
Intense Pulsed Light (IPL) is used in photo-rejuvenation for the skin and hair removal treatments. Broad Band Light (BBL) is essentially the same thing as IPL and is used in the same way. Intense Pulsed Light (IPL) is not actually a laser. IPL emits a non coherent, broad spectrum light, rather than a monochromatic single wavelength like a laser. Basically lasers have one wavelength ( for example: 800nm) with a very specific target, and IPL uses a wide spectrum of wavelengths at the same time (for example: 500nm — 1200nm) that can target any chromophore in that range. You can think of the laser like a sniper that can precisely hit a single target with one shot, and IPL is like a grenade that hits several targets at once.
IPL uses special filters that block unwanted wavelengths. The filters can be changed to “cut off” the shorter wavelengths. The appropriate filter will depend on the depth of the intended target.
The cut off for the wavelength at the deeper end is predetermined, but can vary with each devise.
For example: Lumenis One has a wavelength of 515 – 1200nm,
and has 7 filters: 515, 560, 590,615, 640,695, and 755.
The 515 filter would block out wavelengths above and below 515nm – 1200nm, while the 560 filter would block out wavelengths above and below 560 -1200nm. The deeper wavelength, in this case 1200nm remains the same, while the “cut-off” filter can be changed to block out specific shorter wavelengths.
Each devises may use different wavelengths.
Sciton BBl: 420 -1400nm
Lumenis One: 515-1200nm
iPulse 1200: 530 – 1200nm
LimeLight: 520 – 1100nm
Cynergy XPL: 560 -950nm
IPL is well absorbed by chromophores that have color such as melanin, hemoglobin. The concentration of a specific chromophore peaks at different depths in the skin. The filter used in treatment is decided based on the depth of a desired target and the color of skin. A deeper cut off filter would be used for hair removal, while a shallow filter would be used when treating vascular issues such as rosacea. It is important to remember that IPL targets color in the skin, so tanning must be avoided before treatment. Patients with darker skin should seek treatment from someone experienced in treating their skin type, to avoid complications. IPL treatments can provide beautiful results, but can also cause serious burns. It is the patients responsibility to choose an experienced professional, be honest about sun exposure and follow all pre and post treatment instructions.
There are many variables involved in aesthetic lasers, including the active laser medium, wavelength, and targeted chromophore. Aesthetic lasers can be ablative, non-ablative or fractional. There are also other (non-laser) technology based treatments used in aesthetics such as Intense Pulsed Light (IPL) and Radio Frequency (RF).
The term “laser” originated as an acronym for Light Amplification by Stimulated Emission of Radiation. A laser generates a beam of very intense light. The light emitted by a laser is monochromatic, coherent and collimated.
Monochromatic – the light is of a single wavelength
Coherent - the light beam waves are in the same phase
Collimated - the light beams travel in parallel, all are parallel to each other.
Active Laser Medium Types
The lasing medium is the source of optical gain within a laser. The Active Lasers Medium can be a solid crystal, liquid dye, gas, or semiconductors.
Carbon dioxide (Co2) are gas lasers that are commonly used in aesthetic treatments.
Solid State Lasers
Generally, the active medium of a solid-state laser consists of a glass or crystalline material.
Solid state lasers include Ruby, Aexandrite and Erbium.
Semiconductor-based lasers are also in the solid state, but are considered as a separate class. Diode is a semiconductor based laser used in aesthetic treatments.
A dye laser is a laser which uses an organic dye as the lasing medium. A dye can usually be used for a much wider range of wavelengths which makes them suitable pulsed lasers. Pulsed Dye Lasers are used in aesthetic treatment.
Electromagnetic spectrum is the range of all possible wavelengths and frequencies. Wavelength is the distance over which the wave’s shape repeats ( peak to peak).Wavelenghths are measured in micrometers (microns) and nanometers (nm) Frequency is the number of oscillations per second, measured in hertz.
Energy is the amount of joules (J/cm) delivered. A laser technician adjusts the energy of each treatment, based on factors such as skin type and condition. The laser technician can also control other factors such as spot size and the length and duration of the pulse.
Lasers used in aesthetic treatments target a specific chromophore generally melanin, hemoglobin or water in the tissue. The targeted chromophore is determined by the wavelength. The concentration of a specific chromophore peaks at different depths in the skin. For example hemoglobin in the blood is best absorbed at a shallow wavelength and water is best absorbed at deep wavelengths. Melanin is best absorbed somewhere in the middle (500nm-1064nm), the exact depth can vary, depending on the desired target. For example if you are targeting pigment in the hair follicle a deeper wavelength (640nm-1064nm) would be used, however most lasers used for hair removal are Diodes (800nm-900nm).
Melanin and hemoglobin in blood vessels have color that absorbs the light emitted by specific lasers. Lasers that target color are usually used for hair removal, treating vascular issues such as rosacea and broken blood vessels, and skin discolorations such as freckels. Tanning is contraindicated with laser treatments that target color, tan skin will absorb more heat, increasing the probability of a burn. Tanning can also interfer with the desired results of treatment, because there is less contrast between the intended target and the surrounding tissue. Lasers that are used for hair removal target the color in the hair, so grey or blond hair will not respond well. (There are some lasers that claim to treat grey or light hair).
Water constitutes 80% or more of soft tissue, so lasers that target water are generly used for resurfacing. Lasers with deep wavelenghts such as Co2 or erbium lasers are strongly absorbed by water. The Smoothbeam laser is a 1450nm diode laser that targets water in the skin and is used to treat acne by shrinking the oil gland.
Argon 488 and 515 nm, is a gas laser that emits a blue green light which is strongly absorbed by both hemoglobin and water,used for photocoagulation. Argon lasers are rarely used for aesthetic or dermatologic treatments.
KTP 532 nm, a brilliant green light well absorbed by hemoglobin and melanin used photoablation and photocoagulation. The Iredex DioLite 532 nm KTP that is Diode Pumped, it is used to treat vascular lesions and hyperpigmentation.
Pulsed Dye: 577 -585nm, a yellow light that is well absorbed by hemoglobin in blood. Pulsed Dye Lasers (PDL) are especially useful for the treatment of vascular lesions, including spider veins, strawberry birthmarks and port wine stains.
Ruby 694 nm, uses a synthetic ruby crystal that emits red light that is strongly absorbed by blue and black pigment, and by melanin in skin and hair.
Ruby lasers are used for laser hair removal, tattoo removal and treating pigmented lesions including freckles, liver spots.
Alexandrite Laser 755nm, emits a deep red light and is absorbed by melanin. Alexandrite permits deeper penetration into skin than the ruby, and is used for Laser Hair Reduction.
Diode 800-900nm, emit near-infrared light. Diodes in the 800-900 nm range are absorbed by melanin and used for laser hair removal. The Smoothbeam uses a diode with a 1450nm, it targets water in the skin and is used to treat acne and build collagen.
Nd:YAG 1064nm, laser emits a near infrared beam that can be absorbed by all tissue chromophores, however it is strongly absorbed by hemoglobin. Nd:YAG lasers are used for photocoagulation and photoablation, commonly used to treat broken blood vessels.
Er:YAG 2940nm, emits a mid-infrared beam which has an absorption peak for water. Its used is to ablate tissue for cosmetic laser resurfacing. Also known as Erbium.
CO2 10,600nm, is a gas laser emitting a mid infrared beam which is strongly absorbed by water. Co2 lasers are capable of cutting or vaporizing tissue, and are used for deep laser resurfacing.
Ablative, Non-ablative an Fractional
Non-ablative lasers heat the layers of skin beneath the surface without removing the epidermis (top layer of skin).
Ablative procedures remove the epidermis. Carbon dioxide and Erbium lasers are ablative lasers used in aesthetic treatments. Ablative laser treatments are used for resurfacing, and leave skin raw.
Fractional lasers can be ablative or non-ablative treatments, and target only a fraction of skin at a time, leaving the surrounding tissue intact.
[ Read more on Fractional lasers ]
Some of the lasers used in aesthetic treatments:
Iredex DioLite – 532 nm KTP Diode Pumped – Non-Ablative
Candela Vbeam – 595nm Pulsed dye laser (PDL) – Non-Ablative
Candela GentleLASE – 755 nm Alexandrite – Non-Ablative
Lumenis LightSheer – 800nm Diode – Non-Ablative
Syneron eLaser / Comet – 810nm diode laser ( with RF) – Non-Ablative
Syneron Matrix IR – 915nm diode (with RF )- Non-Ablative/Fractional
Sciton Profile – Nd:YAG 1064 nm – Non-Ablative
Lumenis Multi-Spot – 1064 Nd:YAG – Non-Ablative
Candela GentleYAG – 1064nm Nd:YAG – Non-Ablative
Fraxel re:fine – 1410nm Erbium – Non-Ablative/Fractional
Cynosure Affirm – Nd:Yag 1440nm – Non-Ablative/Fractional
Candela Smoothbeam – 1450 nm diode laser – Non-Ablative
Fraxel re:store – 1500nm Erbium laser – Non-Ablative/ Fractional
Sciton Profile -2940nm Er:YAG – Ablative /(additional attachment to Profile base)
Sciton ProFractional – 2940 Er:YAG – Ablative/Fractional
Lumenis UltraPulse – 10,600nm Co2 – Ablative/ Fractional
Fraxel re:pair – 10,600nm Co2 laser – Ablative/ Fractional
Sometimes a little information can be a dangerous thing.
This is intended to help provide some very basic information of cosmetic / aesthetic lasers. There are many factors involved with laser aesthetic treatments and not everything can be included in this post. Aesthetic laser treatments can be complicated and should only be performed by a qualified and experienced technician.
Cosmetic Laser Warning!
What you need to know before choosing to do a cosmetic procedure.
On one complaint website, there were 1,437 complaints regarding laser treatments and over 600 for one specific laser center. If you decide to go to a 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.
Have you evolved?
Modern humans (Homo sapiens sapiens) have replaced primitive forms of hair removal with the more efficient laser hair removal.
Your not alone
According to the American Society of Plastic Surgeons, in 2009 alone, 159,000 men had laser hair removal treatments.
Laser hair removal requires a series of treatments, a minimum of 8 treatment is needed on non-facial areas such as the back. Treatments are generally done every 6-8 weeks. 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. During a consultation you may be told that they use a laser that is “better” than others and they can remove your hair with fewer treatments. ( That is a BS) Laser hair removal is only effective on hair that is in the anogen stage of growth, regardless of the laser. You may only have only 10% of your hair that is in this cycle at any given time. Even if all of your hair falls out with a treatment, only the hair that was in the Anagen stage at the time of treatment will be permanently removed.
Laser hair removal feels similar to a hot rubber-band snap, so a topical numbing cream may be used to reduce discomfort.
Cost of treatment
A consultation is needed to determine the cost of treatment. Treatment cost is based on the size of the area to be treated, some men have only small patches of hair on their back and others are completely covered. Obviously a man that is 5’10” and 150 lbs is going to have a smaller back than a man that is 6’3″ and 300 lbs.
It is important to go to a reputable laser technician, with plenty of experience with laser hair removal. It is tempting to go to discount laser chains, however a little on-line research will show that these places tend to have a lot of consumer complaints, including burns and disputes over money.