When did the use of lasers in dermatology begin?
In dermatovenereology, the laser has been used successfully for more than four decades, since Goldman in 1963. published the first results of treating skin changes with a ruby laser.
In the last 20 years, revolutionary advances in laser technology have expanded the indications for laser application, from the already mentioned vascular lesions to very successful results in tattoo removal, scarring, permanent hair reduction, skin tightening and shallow wrinkle reduction, and for removing brown spots from the sun ( lentigo solaris). There are also surgical lasers that remove warts, intradermal nevi, pendular fibroids and other benign skin changes.
What is a laser?
Laser is an abbreviation for light amplification by stimulated emission of radiation
The main feature of laser light is that it can be precisely focused on small points with very high energy.
The concept of selective photothermolysis – How do individual changes in the skin absorb laser light?
There are target chromophores in the skin that absorb laser light. The absorption of laser light heats up the target chromophore, and thus the target destroys the change in the skin, without damaging the surrounding tissue.
For the treatment of vascular lesions, the target chromophore is hemoglobin in the capillary, hemangioma, spider nevus or nevus flameus.
Pigment changes on the skin contain melanin that absorbs laser light, just like melanin in the hair root in permanent hair reduction treatments. Therefore, yellow, orange and white hair cannot be treated because there is no melanin.
In rejuvenation treatments, ie. skin tightening, water in the dermis absorbs laser light, and its heating leads to contraction of existing collagen, which immediately after treatment the skin looks tighter, and the full effect is seen after some time as a result of stimulated synthesis of new collagen.
What are the contraindications for laser treatment?
Pregnancy, melanoma and other history of malignant skin tumors, as well as acute infection are contraindications for treatment. In patients with vitiligo, it should be emphasized that new depigmentations may occur on the treated areas of the skin. Each patient should be asked about possible implants and the presence of permanent and temporary fillers in the skin as well as the last treatment with Botulinum toxin type A.
What are the side effects after laser treatment?
During treatment, patients feel tingling, tingling, or burning sensations.
Immediately after the treatment, the skin is red and slightly swollen, and the intensity of the changes varies depending on the type of lesion treated and the type of laser applied.
Transient, rarely permanent, hyper and hypopigmentation may occur, followed by a second-degree burn-like wound, and infection and scarring. Visual impairment is theoretically possible only if the patient removes goggles during treatment.
Can lasers remove hair?
Lasers can be used to remove hair which is a major aesthetic problem especially for women with hypertrichosis and hirsutism. The laser acts only on brown and black hair, and on hair that is in the active growth phase – anagen phase. After the absorption of laser light by melanin in the hair root, it breaks and the hair no longer grows. After 3-6 months when the hair root recovers, the hair starts to grow again, but it is slower and lighter in color. It is important to note that hair can never be completely removed, but a permanent reduction in hair is achieved.
Treatments are repeated 1 month, and the number of treatments is individual, from 4 to more.
The lasers used are pulsed diode laser, long-pulsed ruby laser, long-pulsed alexandrite laser, Q-switched Nd: YAG laser and long-pulsed Nd: YAG laser.
How much treatment is needed to remove vascular lesions?
For dilated capillaries on the face 2 treatments, for numerous capillaries on the skin of the foot 3-5 treatments.
Cherry angiomas and spider nevi are treated with a single treatment. Lasers used in the treatment of vascular changes are KTP, copper vapor / bromide, Nd: YAG and especially pulsed dye laser.
Can scars be removed with a laser?
Keloids and hypertrophic scars are a big problem because traditional treatments do not give satisfactory results. CO2 and Erbium: YAG lasers are useful as an alternative to conventional surgery and can alleviate atrophic scars, while pulsed dye lasers are best for hypertrophic scars. No laser can completely remove scars, but they can be alleviated.
Pigment changes and tattoos
Q-switched ruby laser, Q-switched Nd: YAG laser, Q-switched alexandrite laser and pulsed dye laser are used in the treatment of pigment lesions. Lasers can be used to remove various pigmented lesions such as solar lentigo (age spots), sun spots, café au-lait macula (white coffee spots), naevus Ota, naevus Ito, naevus Becker and tattoos.
Laser “resurfacing” and removal of benign formations
CO2 and Erbium: YAG lasers are used for laser “resurfacing” and removal of benign formations on the skin.
Laser “resurfacing” removes the surface layers of the skin, which can improve skin tone, reduce wrinkles and sun spots. After this treatment, the skin is extremely red, and after a few darkens and peels.
With the non-ablative Nd: YAG laser, only redness appears, which disappears after two hours, without the appearance of skin peeling. The advantage of this laser is that after the treatment you can continue with your usual daily activities.
What are the precautions when handling a laser?
Precautions depend on the type of laser as well as the intensity of the air used. These include:
1. Staff training
2. Eye protection for patients and staff
3. A warning sign (“laser on”) posted at the entrance to the laser room
4.Use of non-reflective instruments
5. Removal of flammable materials from the laser room
