Is Cosmetic Laser Surgery the Tylenol of the Aging Skin?
Dr. Raffi Dishakjian, renowned Los Angeles cosmetic surgeon and medical director of advanced Los Angeles Cosmetic Laser Surgery Center, Nu Vela Esthetica, recently told me about a conversation he had with one of his patients. He started, “Not long ago, a patient came to me with the notion that she needed cosmetic surgery for her sagging face, spider veins, wrinkles, age spots and loose skin. She was in her late fifties, and you could tell she was once very pretty. After my diagnostic tests, I explained to her that she could get rid of all her disfiguring symptoms with cosmetic laser surgery. Her astonishment grew into curiosity, and soon after I was presented with a very interesting question; is cosmetic laser surgery the Tylenol of aging skin?"
Dr. Dishakjian answered with, “Cosmetic lasers are more like the antibiotics of aging skin. Just as you choose the right antibiotic and the correct dosage to target a specific bacterium, you have to choose the right laser and the right settings to target a given set of skin conditions." As a chemist, I myself had worked with a few laser systems in the past while working towards my doctorate in chemistry and consequently found the resemblance to be rather uncanny, which led me to write this article about the working principles of cosmetic lasers.
Laser Technology Simplified
Unlike a light bulb, a laser is a narrow, highly focused, and extremely intense beam of light with unique qualities. The color of light emitted by a laser is determined by the substance (medium) that lies within the laser’s inner chamber. Lasers are usually named after the solid, liquid, or gas substance which is used to generate the beam of light. For example, if the medium is solid ruby crystal, as in the case of a ruby laser, red light is emitted.
Each laser emits a single wavelength of light. The wavelength of a laser beam is directly responsible for its color; two lasers that emit the same wavelength of light will always emit the same color. There are also lasers used for cosmetic purposes that do not produce colored beams. The wavelengths of these lasers are in the infrared region (wavelength longer than red light, 700 nm to 3000 nm), which the human eye cannot see.
Each laser light, characterized by its wavelength, represents a key designed to open only one lock. Wavelength determines which component of the skin (melanin, hemoglobin) will absorb the radiation and how far into the skin the light will penetrate. The ideal laser to affect a given target is the one maximally absorbed by that target. For example, a red substance like hemoglobin, which reflects red light, will maximally absorb green light. Accordingly, a green laser beam will selectively target the hemoglobin found in the skin. The other physical properties of cosmetic lasers that determine their effectiveness are power and pulse duration. These determine how much laser energy is imparted to the skin.
To be useful, a laser used in cosmetic laser surgery must be able to remove or destroy the unwanted skin component without altering or damaging the overall structure of the skin. When strategically selected and combined, the three variables (wavelength, power, and pulse duration) of a laser machine will provide a remarkable degree of precision in targeting a specific skin component and therefore produce the best result.
Ablative and Non-Ablative Cosmetic Laser Procedures
There are two basic types of lasers used for cosmetic purposes: ablative and non-ablative. Ablative lasers actually vaporize the top layers of damaged skin, while nonablative lasers work deeper in the skin without removing or otherwise damaging the top layers.
The most common ablative cosmetic laser procedure is laser resurfacing. The infrared energy produced in ablative lasers has virtually no effect on pigmented skin components and will only target water. Because water is everywhere in the skin, the lasers used in laser resurfacing will virtually vaporize and remove a uniform depth of skin with each pulse or pass. A healing period always follows laser resurfacing, during which superficial skin layers grow back to replace the layers that were removed. Swelling, itching, redness, crusting and tenderness, which may last for several days, are temporary effects of laser resurfacing.
Non-ablative laser treatment is attractive to physicians and patients alike because, contrary to ablative laser resurfacing, there is little if any downtime. Non-ablative lasers work by bypassing the surface of the skin and treating the layers underneath. Non-ablative laser are designed to remove a specific undesired skin component but do not alter overall skin structure. They are used mainly to remove unwanted skin features such as pigmented age spots, birthmarks, vascular lesions (including dilated blood vessels), and excessive hair. Because non-ablative lasers are less intense than ablative lasers, treatment with these lasers require multiple sessions.
Titan Light Therapy and IPL versus Lasers
Though Titan Light Therapy and Intense Pulsed Light (IPL) are often referred to as “laser” procedures, the devices being used are not actually true lasers. Titan and IPL are non-ablative skin treatments that emit powerful bursts of light energy. The light works much like a laser, but instead of having just one wavelength of light, Titan and IPL machines produce a spectrum of light consisting of a range of wavelengths. The Titan system (used to tighten loose and sagging skin) for example, emits infrared light in the range of 1100 nm to 1800 nm for safe and effective heating of the dermis, whereas IPL machines emit a range of smaller wavelengths in the visible and infrared spectrum of radiation. To improve targeting and specificity, IPL devices often use special filters to remove unwanted wavelengths and keep only those in the required range. This makes IPL machines more versatile and suitable for treating a number of different conditions, such as sun and age spot removal, vascular lesion treatment, and hair removal.
What are Fractional Lasers?
Fractional lasers produce the same wavelengths that are used in ordinary laser resurfacing, with the key difference being that they target only a small percentage of the skin. Because only a fraction of the skin is directly targeted with these lasers, the surrounding untreated tissue promotes rapid healing. This stimulates the body’s own natural process for creating new collagen, plumping the skin from below and adding firmness and resilience to the skin. Typically, those treated with fractional lasers can resume work as soon as three days after the initial treatment. Cutera’s Pearl Fractional, Sciton’s ProFractional, and Fraxel are examples of fractional lasers that have become popular these days.
Safety of Cosmetic Laser Surgery and Related Side Effects
There is no evidence that the wavelengths used in cosmetic laser surgery (500 nm to 3000 nm) cause DNA damage or increase the risk of skin cancer. In fact, we are exposed to these wavelengths all day, every time we see something or feel warmth. On the contrary, these lasers have been shown to treat precancerous lesions and reduce the incidence of non-melanoma skin cancers. The long term side effects of lasers used in cosmetic laser surgery have been thoroughly studied and are quite safe. However, even when the correct laser instrument is chosen for a given treatment, there is always the risk of temporary side effects, including immediate pain, reddening of the skin, bruising and swelling. Other possible side effects include the formation of blisters, burns and infection. In some rare cases, there may be lightening or darkening of the skin, but these complications are rarely permanent.
For more information on laser resurfacing, IPL, laser vein treatment, acne scars laser treatment, sun and age spots removal, Titan light therapy, and cosmetic laser surgery in general, please go to the website by clicking the links included above.
Laser Resurfacing at Nu Vela Esthetica, Los Angeles, CA
IPL Treatment for Sun and Age Spots Performed at Nu Vela Esthetica, Los Angeles, CA
Laser Resurfacing for Acne Scars Removal at Nu Vela Esthetica, Los Angeles, CA
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