The word 'Laser' is an acronym: Light Amplification by the Stimulated Emission of Radiation. Lasers are sources of high intensity light which can be accurately focused into small spots with very high energy. Various types of lasers are used to treat a large number of skin problems like removal of wrinkles, unwanted body hair, tattoo and birth marks, scar and stretch marks; skin tightening and facial rejuvenation. The lasers used to treat skin conditions have been in practice for more than 40 years now; and over the time much technological advancement has occurred to improve their efficacy and safety.
Latest Advancement: Fractional Lasers
Fractional laser technology is the most recent and is gaining wide popularity because of its remarkable safety profile, reduced recovery time and significant clinical outcome.
Fractional lasers are the superior and intelligent species of lasers that can be ablative or non-ablative.
How does it work?
The laser light is emitted in a pixilated fashion and transmitted to the skin, which is then split into thousands of microscopic beams, producing tiny dot / pixel-like treatment zones on the skin; referred to as microthermal zones (MTZs). Thereby, it creates small microscopic columns of thermal injury to the skin leaving a large percentage of intervening skin unaffected. The healing occurs quickly in this “fractioned” treatment, hence minimizing the downtime.
The number, depth and size of these vertical columns of MTZs are variable and depend on the type, wavelength, fluence and number of stackings or applications of the laser used.
Currently used fractional lasers:
Examples of branded fractional devices include Fraxel, Pixel and i-Pixel lasers. But there are a number of machines available that use fractional technology, based on Er:YAG lasers (for superficial penetration) and CO2 lasers (for deep penetration).
Fractional CO2 laser and Fractional / Pixel Er:YAG lasers: are ablative lasers which give best possible results in scars, stretch marks, fine lines, visible photo aging, wrinkles and age spots.
i-Pixel Laser: The recent introduction of i-Pixel Erbium technology (in-motion laser) has completely revolutionized the approach. It has 7 times more penetration power than pixel laser; yet it is very precise and safe to be used over delicate areas like face. It produces better texture changes and has less downtime with minimal risk of pigmentation. Thus it gives the penetration and efficacy of CO2 laser minus its side-effects. Unlike traditional Erbium lasers which use a stamping or scanning technique, i-Pixel Erbium laser can treat a targeted area exclusively. This not only speeds up treatment time but also significantly decreases recovery time. Moreover, the number of sittings required is less and it gives much better results in terms of cosmetic acceptability when compared to other ablative lasers.
Fractional Er:Glass laser: on the other hand is non-ablative laser used for all above-mentioned indications with the benefit of no downtime and definitely has less side-effects; but it is less effective (as its penetration is only superficial). The patients need multiple sittings for the desired results and the results are relatively short-lived.
Pixel Q-Switched Nd:YAG laser: is the latest kid on the block and is a major technological advancement. It has completely revolutionized the facial rejuvenation procedure; by offering collagen remodelling and skin tightening at the deeper skin layers but with ZERO DOWNTIME! This will give you a glowing skin within minutes; and you can enter straight into a party and flaunt your vibrant skin, without letting anyone notice the procedure you have undergone minutes before!
It is also used for Tattoo and birth mark removal and gives unbelievable results.
Safety precautions will depend on which laser system is used and in what setting. They should include:
- Thorough training of personnel
- Eye protection for the patient and clinic staff
- Warning notice outside the procedure room
- Use of non-reflective instruments
- Avoidance of flammable materials.
Intense pulsed light (IPL)
IPL is not a laser but a technology used by medical practitioners to perform various skin treatments including photoepilation (hair removal) and photorejuvenation. This technology utilizes specific wavelengths of light to target various chromophores in the skin.
The primary difference between Laser and IPL is that lasers use coherent light of a single fixed frequency while IPL uses non-coherent light distributed over a range of frequencies between 500nm and 1200nm.
Commonly used Lasers in Dermatology
- CO2 Lasers: have a wavelength of 10600nm. The laser light from these lasers is absorbed by water in the skin, hence, used for skin resurfacing, removal of benign skin tumors like warts, xanthelasma, mucous cysts, cherry angiomas, leukoplakia and for surgical cutting.
YAG Lasers: YAG is the acronym for Yttrium Aluminum Garnet (Y3Al5O12), a synthetic crystal material which became popular in the form of laser crystals in the 1960s. The term YAG laser is usually used for solid-state lasers, which are usually doped with Neodymium (Nd:YAG) or Erbium (Er:YAG).
- Nd:YAG Lasers: have a wavelength of 1064 nm and the active medium is Neodymium in yttrium-aluminum-garnet. Nd:YAG lasers have slight absorption in melanin and hemoglobin and are used for laser hair removal, laser vein treatments, laser photo rejuvenation, laser acne treatments and in laser skin surgeries.
- Q-Switched Nd:YAG Lasers have strong absorption in dark tattoo inks, hence used in laser tattoo removal.
- Er:YAG Lasers have a wavelength of 2940nm and the active medium is Erbium in yttrium-aluminum-garnet. It is absorbed by water in the skin and is used for skin resurfacing, laser photo-rejuvenation and for removal of skin growths.
- Er:Glass Lasers: This Erbium doped glass laser has a wavelength of 1540nm. It is non-ablative laser and is used for skin rejuvenation, skin resurfacing and stretch mark removal.
- SSR 540 Laser: This laser works in the domain of 540-950nm wavelength. It is used for instant glow on the face, so also known as 'Party time Laser'. It is also very good for targeting small, reddish brown patches over the skin.
- Acne 420 Laser: This laser gives instant relief for active acne, reddness and post acne marks by targeting P. acne, the most common causative organism in acne. It is also known as Clear light 420 laser.
- UVB Laser: It works within domain of 300-380nm of wavelength and is mainly used in psoriasis and vitiligo. It selectively hits the target area while avoiding the healthy skin. Total number of sessions required is 12-16 and it gives significant improvement to the client. Though results vary from person to person and various contributory factors need to be controlled. These Lasers help in reducing medication toxicity inside body and at the same time focussed approach only at the disease area.
- Ruby lasers: have a wavelength of 694 nm and contain Chromium ions in aluminum oxide as the medium. Ruby laser light has very strong absorption in melanin and black and dark blue ink pigments. These are especially useful in tattoo removal. Laser hair removal and removal of pigmented (dark) skin lesions.
- Alexandrite Lasers: 755 nm, Q switched mode laser, used to remove blue, black and green tattoos and epidermal and dermal pigmentations as in melasma.
- Diode Lasers: have different wavelengths. The absorbing chromophores are melanin and hemoglobin in the skin. Diode lasers are used for laser hair removal, dilated vein treatments, and laser photo-rejuvenation.
- Dye Lasers: contain organic compounds in solution (often rhodamine) as the active medium and have wavelength activity between 400 to 800 nm. The target chromophores are hemoglobin and melanin pigment. Dye lasers are useful in treating vascular lesions and for non-ablative skin rejuvenation.
- Excimer Lasers: containing compounds of xenon, krypton and argon target proteins and water and have wavelengths between 190-350 nm. Excimer lasers are useful in the treatment of psoriasis and vitiligo. These are also used for Lasik eye surgery.