What is Laser Therapy?
Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Laser therapies are sources of high intensity and monochromatic light, emitting light of only one wavelength (or color).
The aim of lasers is to focus on a small area to destroy the target cells and not harm the surrounding tissue. Different lasers with various wavelengths target different pigments. Some lasers focus on brown pigments (melanin) by minimizing the appearance of dark spots. Others focus on red pigments, penetrating blood vessels, capillaries or acne scars, create micro sized wounds, stimulating the body’s renewal response to generate new collagen, and reducing lines and wrinkles.
Types of Lasers and their different cosmetic uses
The main differences between the types of lasers have to do with wavelength, with different laser wavelengths (colors of light) targeting different skin issues. There are two main types of lasers that can be broken down further into many different subcategories of laser types.
These lasers focus on the outer layer of skin, removing layer of skin and penetrating the tissue beneath to create micro wounds. Ablative lasers include CO2 and Erbium, which are more invasive, but produce the best clinical results. They work by vaporizing the outer layers of the skin, causing the skin to heal and restructure, and increase collagen production. These lasers are great for treating visible signs of aging and the results generally last for one to five years. They can also be used to treat acne scarring, pigmentation irregularities and unwanted lesions. However, a longer recovery and higher degree of risk are expected compared to non-ablative lasers. Most patients require one to two weeks of recovery time.
Carbon Dioxide Laser (C02) was first introduced during the late ’60s and is still being used for skin rejuvenation. Due to its side effects, it has largely been replaced with fractional mode lasers, which has fewer side effects and heals faster. It is not suitable for darker skin tones. It is used in treating skin cancer, acne scars, deep wrinkles, sagging skin, birthmarks, moles, skin tags, other scarring warts, corns on feet, and photo damage. However, side effects include a long recovery process, skin redness, pain, itching, burning sensation, and scarring.
Erbium Yttrium-Aluminum-Garnet (Er:YAG) helps remove surface and moderately deep lines and wrinkles on the face, hands, neck or chest with minimal burning of surrounding tissues. This has lesser side effects and it heals faster than CO2 laser treatment. It is used to treat pigmentation problems, acne scars, fine lines, small to moderate wrinkles, and moles. Some side effects include redness, swelling, and bruising, which may last for up to two weeks.
Erbium Yttrium-Aluminum-Garnet (Er:YAG) lasers are solid-state lasers that helps remove surface-level and moderately deep lines and wrinkles on the face, hands, neck or chest with minimal burning of surrounding tissues. With lesser side effects, it heals faster than CO2 Laser treatment. Er:YAG lasers typically emit light with a wavelength of 2940 nm, which is infrared light. Unlike Nd:YAG laser, the output of an Er:YAG laser is strongly absorbed by water. This fact limits the use of Er:YAG laser in surgery, and in many other laser applications, to where water is present. It is used to cure pigmentation problems, acne scars, sun damage, fine lines, small to moderate wrinkles, and moles. Side Effects include redness, swelling, and bruising, which may last for one to two weeks.
Er:YAG lasers are used for:
Non-ablative or “non-wounding” lasers pass through the outer layer of skin, penetrating the tissue beneath the skin without removal of tissue. Non-ablative lasers are used for mild to moderate wrinkles and scars, and can be combined with other treatments such as chemical peels, scar revision and botulinum toxin injections. Several non-ablative lasers used for skin rejuvenation for the removal of skin pigment or blood vessels include Q-Switched Nd:YAG and Pulsed Dye Laser.
Pulsed Dye Laser (PDL) is useful in the treatment of port wine stains (vascular malformation), superficial haemangiomas and a variety of vascular lesions including telangiectasis and cherry angiomas. PDL is also widely used to treat several nonvascular conditions such as plane warts, angiofibroma (tuberous sclerosis) and pyogenicgranulomas. Light energy emitted by the flashlamp-pumped PDL is primarily absorbed by oxyhemoglobin within the blood vessels, minimizing thermal damage to other structures. In general, port-wine stains fade by 80% after eight to 10 treatments. Lesions on the face or neck tend to respond more quickly than those on the lower regions.
A quality-switched laser (Q-Switched) is non-invasive as it creates high-intensity pulsed beam light, lasting a mere billionth of a second. The energy emitted from a Q-switched laser is concentrated into very powerful pulses. Q-Switched lasers are able to shatter tiny fragments of pigmentation or ink, stimulate collagen production or kill fungus. Due to their contact with the skin is less than other lasers, Q-Switched lasers are known for not damaging surrounding tissue and causing unwanted side effects. Some Q-Switched lasers include Nd:YAG, named after the laser medium, Neodymium-doped Yttrium Aluminum Garnet, is a crystal that is used as a laser medium for solid-state lasers. It is a four-level laser system, involving four energy levels in laser action. It is specifically designed to help with pigmentation, darkened scars, brown birthmarks and even old tattoos. These lasers operate in both pulsed and continuous mode. Nd:YAG laser generates laser light commonly in the wavelength spectrum at 1064 nanometers (nm) and 532nm. It also emits laser light at several different wavelengths including 1440nm, 1320nm, 1120nm, and 940nm. These specific wavelengths are absorbed by melanin and the resultant heat will then cause damage to the pigmented cells and will then be cleared from the area.
Q-Switched lasers are used for:
Alexandrite Laser emits wavelength of high energy light that is converted to heat energy. This laser uses the process of photothermolysis, which means using light (photo) to heat the targeted area for destruction. Alexandrite lasers cause very precise tissue destruction of the lesion and leave tissue in the surrounding area undamaged. It is used to treat skin conditions such as hyperpigmentation, birthmarks, and is also useful for hair removal, tattoo removal and leg veins. Side effects include pain during treatment, as well as redness, swelling and itching that may last for a few days.
Lines and Wrinkles
Through a combination of skin resurfacing and skin tightening procedures - both can be accomplished with a more aggressive ablative laser, such as a CO2 or Er:YAG lasers. Pulsed dye lasers have also shown some success, along with less aggressive non-laser, light-based treatments, such as IPL, LED, and Thermage radio-frequency based systems.
Acne and Acne Scars
CO2 laser remains the best option for deeper acne scars, though Er:YAG, fractional laser and certain non-ablative lasers have also shown considerable success with superficial acne scarring. For the treatment of active acne, LED technology has proven to be quite effective.
For sun or age spots, melasma and other forms of pigmented lesions, pulsed dye, Nd:YAG and fractional (Fraxel) lasers are commonly used, along with non-laser, light-based treatments, such as IPL.
For conditions like broken blood vessels on the face, unsightly spider veins, hemangiomas, and certain birthmarks such as port wine stains, pulsed dye, Nd:YAG, diode lasers and IPL are commonly used.
Most cosmetic laser procedures provide at least some level of superficial tightening because they produce a controlled injury of the skin, which encourages increased collagen production. But for more significant tightening results, CO2 lasers are the laser of choice as well as some non-laser, light-based treatments such as Titan infrared devices and Thermage radio-frequency based systems.
Ablative lasers such as CO2 and Er:YAG, are generally chosen for removing precancerous growths, such as actinic keratoses, before they have a chance to become malignant, as a preventative measure.
CO2 and Nd:YAG are most popular options.
The success and safety rate is highly dependent on the pigment present in both the skin and the hair of the patient being treated. For darker-skinned patients, the Nd:YAG and diode lasers are often the lasers of choice, and for lighter-skinned patients, IPL has proved effective.
Procedure and Treatment
Numbing cream will be applied 30 to 60 minutes before the treatment to minimize any discomfort. Your medical doctor will direct the laser onto the targeted skin site for treatment. A slight stinging sensation may still be felt but treatment is very well tolerated most of the time, so there is no need to take painkiller. The whole procedure will take about 45 minutes. After the procedure, you may experience redness over the treated site which may last a few hours. Most of the time, there is no swelling and most patients can return to work almost immediately.
Post laser, skin lightening and rejuvenation may be seen immediately but not with lightening of pigmentation. In fact, the pigmented spot may even darken for one to two weeks before getting lighter. The results of laser and light-based treatments and recovery vary, depending on the type of procedure employed. Mild treatments, such as those with low-powered lasers typically have fast recovery times, generally a few days to one week, as this type of treatment does not result in peeling, oozing or crusting of the skin. The more aggressive laser treatments require a longer recovery period, with skin typically experiencing various stages of redness, oozing, crusting and peeling for one week. After that, the skin may remain pink for up to another one to two weeks.