The main task of this article is to get acquainted a curious user and a potential client that is going to undergo some of the procedures from the field of corrective dermatology, just with the amount of magic light energy flows, which is really surprising. The same can be said also about the possibilities of their usage: not just the wrinkle, vascular and pigment lesions correction, permanent reduction of undesired hair but also even the removal of varicose veins, acne and psoriasis treatment and painless skin rejuvenation.
We should have in mind that lasers are often related to magic effects thanks to the massive media campaign, which they do not have. As well as their advantages, such as simplification of treating procedures, acceleration and simplification of healing process are compensated with high price that is usually in most cases paid by the patient because the laser treatment still does belong to the above-standard treatment.
And now already a description of each group, to which are lasers that are used in dermatology, divided according to the type of skin treatment.
Lasers for Vascular Lesion Treatment
Laser VersaPulse VPW
Vascular lesions are divided in congenital and acquired. To the congenital lesions belong for example so-called naevus flammeus, known as port-wine stain. It is an esthetically bad looking congenital defect, which is caused by accumulation of enlarged blood vessels. A part of the acquired malformations are for example so-called spider veins, small veins on legs, Slavic women have allegedly the biggest problems with them in Europe. Of course that there are more types of vascular lesions, but a specific laser may be of help to the majority of them.
The laser for vascular lesion treatment went through several phases of development. Already in the 80’s the argon laser was used in Bohemia (at Dermatology Clinic at General Faculty Hospital in Prague). Shortly after that it was changed by so-called dye lasers, there was achieved optimum increase of energy, although imperfect range of pulse energy. This has often led to the creation of pressure wave inside the treated vessel, and to its consequent burst and therefore small bruises were often formed. The patients did not like it too much, luckily in the 90’s the scientists finally evolved fully suitable type, so-called KTP laser with double frequency and long pulse. It enables enough deep penetrating of laser beam energy into the vessel and because the formed heat does not localize into the spot, there is no crash wave and redness. Moreover this laser works with special cooling sapphire explorer, which also prevents the redness. The cooling has also an analgesic effect. Vascular lesions are treated with this type of laser until today and its excellent complex characteristics pose it on the imaginary laser top aimed for treatment of vascular defects.
Lasers for Pigment Lesion Treatment
According to that the pigment stains can present a symptom of starting malign melanoma, it is always good to consider carefully, if it is not better to cut the stain out with classic method. Here it really is a question of health and many times even of life and the esthetic feelings have to therefore go aside. However, not every pigment lesion is a potential skin tumor. To the most frequent skin pigment stains belongs melasma, often occurring during the pregnancy or when taking oral anticonception. Unfortunately it is hard to heal it; the usage of laser is approached only in extreme cases. As for tattoos it is possible to use for example so-called Q-switched laser. This laser can evoke an effective appearance called photo-disruption, when it literally “breaks up” the pigmentation. Photo-disruptive lasers have extremely short pulse around millionths of a second and therefore it disposes of very high pulse energy. They represent with little exaggeration such laser pistols.
Laser for Vaporization of Unwanted Skin Lesions
Laser UltraFine Erbium
Vaporization or evaporating is a method of using photo-ablative effect, i.e. removal of lesion by light. This technique uses vaporizing CO2 lasers or Erbium lasers. However, they are not produced anymore. Present development in the field of vaporizing lasers aims to improvement of CO2 lasers. Perfect technical characteristics of carbon dioxide laser with ultra short pulse almost crowded out even the originally biggest advantage of Erbium lasers, i.e. shorter time of healing.
Lasers for Tattoo Treatment
Here is still very popular topic tattooing – although in this case we talk about its removal. It is still very fashionable to decorate your body with more or less well done pictures, unfortunately people do not think about how is their mermaid that is tattooed on their belly going to look like after thirty years (and in many cases even after thirty kilograms) or if the name of your honey, which is now nicely surrounding your arm is going to be relevant even next year. In short, people consider the decoration of the skin still very freely and thoughtless and then they complain in the offices of the dermatologists, expecting a miracle. Instead of that a very complicated process is waiting for them and the final effect does not have to be satisfactory at all. And this even today when the surgeons use the most modern laser technique. The structure of incorporated color is not always very clear, so often unpleasant surprises occur. The usage of some wavelengths causes a change from bivalent iron to trivalent iron. The result when removing for example wrong done red lip contour is a change to more visible black color. Another problem represents still more and more popular multicolor tattoos. It is necessary to dispose of several wavelengths (i.e. several lasers) to remove them. Finally a person that had his/her tattoo done does not take into account that its removal is in most cases more expensive than its purchase. The list of lasers for tattoo removal partially coincides with the list of laser for pigmentation removal – it means again a system of “breaking up” the pigment. Here we have to take into consideration also already mentioned color tattoos. The only laser VersaPulse C Aesthetic has 4 different wavelengths in one system. The advantage of using the most modern lasers is the absence of scar after the removal. To spare you from inconveniences and even the content of your wallet it is warmly recommended to think more in advance about the appearance, placement and size of the tattoo according to coming years.
Biostimulation laser Medec
Lasers for Scar Treatment
Even though the surgeons can do many things today, they cannot still make miracles and this is valid absolutely about the treatment of scars. It is impossible to fully recover an inferior scared tissue, which is often hard to put up with for the patients. However the surgeons can contribute to an essential scar modification for better, i.e. its reduction, thinning, discoloring and so on. The ability to treat a scar also depends on the type of scars and even on a whole range of other factors, such as age, gender or photo type. The treatment is usually a combined method, in which laser therapy is only a part of it.
According to scar types (for example atrophic, hypertrophic, keloid or very unfavorable striae in women) a laser type is chosen.
Lasers for Unwanted Hair Removal
Many women and even men despair of the extent or location of unsightly hair. Even this unpleasant aesthetic problem can be solved with laser. The advantage is a permanent reduction, which means that after a repeated treatment there is no reason to be afraid that the hair will start to grow again. The development of so-called epilatory lasers has progressed a lot and the top laser among their overflow is an American, already several times improved laser, which is called LightSheer. This laser or the precedent lasers that are still in function can get you rid of the hair practically anywhere on the body.
Lasers for Varicose Veins Treatment
Varicose veins or varices – habitually known and unpleasant problem that bothers seniors and women after the delivery. For all those who expect a surgical procedure with stay in hospital and a sickness leave, we have pleasant information; even here laser methods are in use. The usage of beam brings a fundamental comfort, it is performed as an out-patient procedure, the patient can go home after not even an hour and he/she can immediately return to his/her all activities without having a sickness leave. This is very nice to hear, the reason for this is a diode laser with one-time set. The method consists in inserting an optical fiber, which is capable to transfer the laser pulses into the vein. When taking this fiber out of the vein, it is step by step sealed, which prevents the back blood flow and therefore even its accumulation in the veins. According to the amount of the patients that suffer from varices as well the fears from possible complications after surgeries, this novelty is really very exciting and it started a new era in extension of treating methods of this very frequent defect.
Devices for Psoriasis and Vitiligo Treatment
And another skin problem –psoriasis. It is a chronic disease; although life is not in danger, the disease is very severe and dragging, bringing many times a big sufferance for the patient. Prevention or specific treatment are not yet known. So as vitiligo, another troublesome skin disease, caused by drop-outs of pigmentation. The cells that form pigment die away; it is not very rare. 1-4% of all citizens suffer from it. Also here the cause is not known yet.
Nevertheless even in this case the usage of laser presents a converting event. At World Dermatology Congress in Paris in 2002 a new device was introduced in European first run BClear (producer Lumenis). It is said that the focus of psoriasis weakens already after 1-2 sessions, after total 4-6 sessions it completely disappears. The system uses focused fiber optics with therapy of high doses without damaging a surrounding healthy skin; this is performed with the help of contact ending with active size 16x16mm. It is a device made especially on requests of dermatologists. The aim of the method is to replace to a certain extent medicamentous treatment of psoriasis with the use of light. It is very interesting that even though it is a disease where a genetic disposition plays its role, in an overwhelming majority of cases a recurrence does not occur. However, it is relatively fresh novelty, to confirm long-lasting effects of this method there are not enough data. So it is good to have a certain restraint, although it has been clear even now that laser will present a big turning-point in the treatment of psoriasis and vitiligo.
Laser D15 for varicose veins removal
Lasers for Acne Treatment
Acne vulgaris – inflammatory skin disease that is manifested by eruption of ugly, inflamed pimples, well known by almost all of us. It is also a great origin of complexes and difficulties in the puberty, in case of such troubles, that forced us to ill-judged acts that even worsened the state of the skin. Many people have these annoying pimples even in the adult age, which presents a state that is usually perceived as double indignity. Luckily there is a large amount of methods in today’s dermatology how to end up with this disease or at least markedly limit its symptoms. One of them is also a laser treatment method. The light laser treatment shows as very effective. In principle it is a usage of big amount of endogenous porphyrin, an organic chemical combination that spontaneously discharges Propionibacterium acne (co-responsible bacteria for acne creation). A selective photothermolysis works here so that these porphyrins are “turned on” with high doses of above mentioned specific light, which leads to photodestrution of these bacteria. Clinical studies prove that through this method up to 90% of bacteria P. acne are killed. This process comes approximately three times faster compared to oral antibiotics or local preparations.
Biostimulation lasers or Soft Lasers
In the list of lasers there should not be missing so-called biostimulation lasers, those are lasers used in dermatology especially as additional method for acceleration of wound healing. They are most often used in treatment of herpes, acne, decubitus or scars.
IPL - Intense Pulse Light
An Intense Pulse Light, a procedure known more under the abbreviation IPL (Intense Pulse Light) or among the patients it is called an iron, in the Czech Republic it has been used for last several years. It is a polychromatic not laser therapy that uses effects of various wavelengths at the same time. These systems find today their use in so-called photorejuvenation or skin rejuvenation with light. A significant correction especially of colored skin modification can be achieved, i.e. vascular and pigment defects and also improvement of skin quality, such as refinement of wrinkles and texture of the skin. For improvement of quality of drooping skin and its tonization a so far newest method is still more used, it is called:
At present uniquely dominates a system of so-called bipolar radio frequency with suction bipolar headpiece – a device known as ALUMA, a company Lumenis. The sucked skin stays untouched during the procedure; on the other hand the targeted warming of dermal collagen leads to stimulation and its regeneration and following firming of drooping facial skin.
Author: Hana Adamcova, M.D., chief surgeon
Editor’s notice: The text was modified and shortened
Original version written for “Trends in medicine” year 4 2002/03, an article with the title “The usage of lasers in dermatology”, innovated version as a book Trends in medicine, a collective of authors, publisher Triton: “Dermatovenerology, children’s dermatology and corrective dermatology” 2006/2007