In 1960, when Bell Laboratories patented the laser (Light Amplification by Stimulated Emission of Radiation), they really had no idea exactly what its possibilities might be. With the advent of solid state electronics it has come into its own. It is used in industry for cutting and welding, in entertainment in CD & DVD players and video devices, in office applications like laser printers, and since the early 1990's it has had burgeoning uses in medical applications. One of the primary medical uses is in the practice of aesthetic medicine, where the object is beautifying and improving the appearance of skin. Whether it is from aging, tattoos, birthmarks, or degeneration of the collagen protein which underlies the lesions under the surface.
It has replaced such procedures as dermabrasion for acne scarring so that recuperation is a fraction of what it had been. It has replaced the absolute need for many surgical procedures such as facelifts and vein-stripping of varicose veins. It has become clear that one laser cannot be used for all medical purposes. What it does and how it affects the skin is determined by miniscule changes in light bandwidth, light photon power delivered by the device, and the length of the skin exposure to the light and most importantly is the cooling and removal of the unwanted heat from the site where the laser is administered.
If one looks at the entire spectrum of light, it is evident that the human eye only "sees" a fraction of the light which is present. In other words human vision can see light waves in the range of 400 to 1000 nanometers. This includes a portion of UV light and almost to the infrared area. Light is in discrete packets of energy called photons. Photons are released by electrons when they go from a higher energy state to a lower one. The way laser works is that it releases photons from an energized tube that are traveling parallel to another and at an equal energy composition. Some of the first medical work done was with a carbon dioxide laser. The light released was of a wide width, about 10,000 nanometers. It targeted water in the human skin, and was useful in cutting tissue, and at lower energy levels it could be used for laser resurfacing, though the skin surface would get very hot and recovery time was prolonged.
There are now a number of different lasers which release specific wavelengths of light. One of the first used was the Argon laser, who use is primarily limited these days to specialized eye and ear applications. Probably one of the well-accepted lasers these days is the YAG laser (Yttrium-Aluminum-Garnet). It is combined with Erbium, Neodymium and other elements to produce light at specific wavelengths which may target water, hemoglobin, melanin, or tattoo pigments in the skin. A laser's propensity to target melanin makes it useful to target melanin in the root of a hair, and thus act as a hair-removal device. By targeting hemoglobin, it can explode tiny blood vessels which cause rosacea on the face. Other uses are based on specific pulse widths, amount and time of energy delivered, and known biological effects of each one.
There is another form of light therapy which is normally delivered either by the device itself or by way of the armature of a laser (through a boxed lens device) called BBL (broad-based light); it is often known as IPL with frequently replaced light bulb (intensive pulsed light). If you have an IPL done check the usage of the bulb with the practitioner. A bulb costs about $10,000 and is effective for 10,000 flashes after which the results fade very quickly. If they only charge $1.00 per flash you do the arithmetic. This light therapy includes several wavelengths of light simultaneously such as light including everything from 480 to 1064 nanometers. Certain filters can be put in the box to shield out certain wavelengths for specific purposes.
Lasers create a lot of heat in the skin by virtue of what they do. There are several techniques for making the procedure more comfortable. Many times an oral anti-anxiety medicine like diazepam is given prior to the procedure to alleviate fear and apprehension. The gel which is applied to the face as the procedure progresses may be refrigerated to decrease the heat. Most of the time a topical anesthetic containing one or more of the "-caine" drugs like xylocaine or mepivocaine is applied prior is applied prior to the procedure to numb the skin. Once the procedure is started there are ways to continuously cool the skin. One way is to blow cold air over the work field from a special cooler. Another way is an expensive sapphire glass which has coolant run directly through it at the site of the laser's penetration. The discomfort usually abates a few minutes after the procedure is completed.
The laser techniques, in the hands of an experienced operator, are an excellent way to rid the skin of wrinkles, blemishes, acne scars, and the general effects of aging. The limited IPL's that a lot of the spas are using simply cannot do the job in all cases. A patient, who is interested in a specific laser improvement to the face or other part of the body, should consult an experienced physician before embarking on any type of laser therapy.
John Drew Laurusonis
Doctors Medical Center