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What is laser skin resurfacing?

 Laser skin resurfacing, also known as a laser peel, laser vaporization and lasabrasion, can reduce facial wrinkles, scars and blemishes. Newer laser technologies give your plastic surgeon a new level of control in laser surfacing, permitting extreme precision, especially in delicate areas. 

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What laser skin resurfacing can improve

 

  • Fine lines or wrinkles around or under your eyes, forehead or mouth
  • Scars from acne or chickenpox
  • Non-responsive skin after a facelift
  • Aged or sun-damaged skin
  • Liver spots
  • Improve your complexion if you have yellowish or grayish skin tones
  • Warts
  • Birthmarks such as linear epidermal nevi
  • Enlarged oil glands on the nose

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How does laser skin resurfacing work?

 It's all about using beams of light. Your surgeon uses the laser to send short, concentrated pulsating beams of light at irregular skin. This removes unwanted, damaged skin in a very precise manner one layer at a time. Laser skin resurfacing's targeted approach means there are fewer problems with hypopigmentation, or a lightening of skin, for procedures such as laser acne scar removal.The laser beam used in laser resurfacing will remove your outer layer of skin, called the epidermis. It simultaneously heats the underlying skin, called the dermis. This action works to stimulate growth of new collagen fibers. As the treated area heals, the new skin that forms is smoother and firmer. 

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What skin conditions can be treated with lasers?

 Lasers have been used successfully to treat a variety of vascular lesions including superficial vascular malformations(port-wine stains), facial telangiectases, haemangiomas, pyogenic granulomas, Kaposi sarcoma and poikiloderma of Civatte. Lasers that have been used to treat these conditions include argon, APTD, KTP, krypton, copper vapour, copper bromide, pulsed dye lasers and Nd:YAG. Argon (CW) causes a high degree of non-specific thermal injury and scarring and is now largely replaced by yellow-light quasi-CW and pulsed laser therapies.The pulsed dye laser is considered the laser of choice for most vascular lesions because of its superior clinical efficacy and low risk profile. It has a large spot size (5 to 10mm) allowing large lesions to be treated quickly. Side effects include postoperative bruising (purpura) that may last 1-2 weeks and transient pigmentary changes. Crusting, textural changes and scarring are rarely seen.The new V-beam features provide ultra-long pulse duration so greater is energy directed at the target blood vessels over a longer period of time, resulting in more uniform blood vessel damage. This reduces the purpura seen with the earlier pulse dye lasers. The addition of dynamic cooling increases comfort during treatment enabling higher fluencies (energy) to be delivered safely and effectively, so fewer treatments are required.Vascular malformations associated with smaller more superficial blood vessels respond better to treatment than deeper larger vessels (more often arising in older individuals). It is therefore best to begin treatment early. Fading by 80% occurs after 8 to 10 treatments on average. Further treatment may be necessary if the lesion recurs.Treatment with quasi-CW lasers also produce effective outcomes but they are may be associated with higher incidences of scarring and textural changes. The most common side effects include mild erythema, oedema, and transient crusting.Non-laser intense pulsed light devices can also be used for treating vascular lesions. 

 

  

 

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Pigmented lesions and tattoos

  Melanin-specific, high energy, QS laser systems can successfully lighten or eradicate a variety of pigmented lesions. Pigmented lesions that are treatable include freckles and birthmarks including some congenital melanocytic naevi, blue naevi, naevi of Ota/Ito and Becker naevi. The short pulse laser systems effectively treat the lesions by confining their energy to the melanosomes, which are the tiny granules containing melanin inside the pigment cells. The results of laser treatment depend on the depth of the melanin and the colour of the lesion and is to some degree unpredictable. Superficially located pigment is best treated with shorter wavelength lasers whilst removal of deeper pigment requires longer wavelength lasers that penetrate to greater tissue depths. Caution is needed when treating darker-skinned people as permanent hypopigmentation and depigmentation may occur. Successfully treated lesions may recur.Prior to any laser treatment of pigmented lesions, any lesion with atypical features should be biopsied to rule out malignancy. The treatment of congenital melanocytic naevi is a controversial issue. The long-term effect of using lasers on promoting melanoma is not known but the treatment is thought to be low risk.The QS laser systems can selectively destroy tattoo pigment without causing much damage to the surrounding skin. The altered pigment is then removed from the skin by scavenging white blood cells, tissue macrophages. The choice of laser depends on the colour, depth and chemical nature of the tattoo ink. Two to ten treatments are often necessary. Yellow, orange and green colours are the most difficult to remove.

  • Black: QS ruby, alexandrite or Nd:YAG
  • Blue and green: QS ruby, alexandrite
  • Yellow, orange, red: QS Nd:YAG or PDL

As with other laser treatments, pigmentary and textural changes including scars may occur.  

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Hair removal

 Lasers can be used to remove excessive and cosmetically disabling hair due to hypertrichosis or hirsutism. Laser treatments remove dark hair quickly and it may take 3 to 6 months before regrowth is evident. Several treatment cycles are required with the spacing between treatments dependent on the body area being treated. Laser treatments are less painful and much quicker than electrolysis. Complications are rare but superficial burns, pigmentary changes and even scarring may occur. Increased growth of fine dark hair in untreated areas close to the treated ones has been reported. Both increased and reduced localised sweating have been reported after treatment.Suitable devices include long-pulsed ruby and alexandrite lasers, diode (810nm), millisecond Nd:YAG and non-laser intense pulsed light.

What dermatologists treat: The lasers designed for hair removal can be used on most parts of the body. Many lasers effectively treat large areas. Laser hair removal can treat the:

  • Back.
  • Bikini area.
  • Chest.
  • Face, especially the upper lip and chin.
  • Neck.
  • Shoulders.

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Facial wrinkles, scars, and sun-damaged skin

 Facial laser resurfacing uses high-energy, pulsed and scanned lasers.Pulsed CO2 and erbium:YAG lasers have been successful in reducing and removing facial wrinkles, acne scars and sun-damaged skin. High-energy, pulsed, and scanned CO2 laser is generally considered the gold standard against which all other facial rejuvenation systems are compared. Typically a 50% improvement is found in patients receiving CO2 laser treatment. Side effects of treatment include post-operative tenderness, redness, swelling and scarring. The redness and tenderness last several weeks, while new skin grows over the area where the damaged skin has been removed by the laser treatments (ablative laser systems). Secondary skin infection including reactivation of herpes is also a potential problem until healing occurs. Extreme caution is needed when treating darker skinned individuals as permanent loss or variable pigmentation may occur longterm.Erbium:YAG produces similar results and side effects to CO2. Despite their side effect profile and long recovery time these ablative laser systems, when used properly, can produce excellent results.Recently non-ablative lasers have been used for dermal modeling; 'non-ablative' refers to heating up the dermalcollagen while avoiding damage to the surface skin cells (epidermis) by cooling it. Multiple treatments are required to smooth the skin.  

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Keloids and hypertrophic scars

 Keloids and hypertrophic scars are difficult to eradicate and traditional treatments are not always successful. Vaporising lasers (CO2 and erbium:YAG) have been useful as an alternative to conventional surgery. More recently PDL has been used to improve hypertrophic scars and keloids. This may require multiple treatment sessions or the simultaneous use of intralesional injections to gain good results. The PDL has been reported to reduce the redness as well as improving texture and pliability of the scar.  

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Other uses

 Lasers are sometimes used to remove viral warts by vaporization (CO2 laser) or destruction of the dermal blood vessels (PDL) but the evidence would suggest that this is no more effective than standard wart paints or even waiting for spontaneous clearance.The CO2 laser can be used to remove a variety of skin lesions including seborrhoeic keratoses and skin cancers by vaporization or in cutting mode. However, conventional surgery or electrosurgery can also be used and is generally less expensive.Violet-blue metal halide light (407-420 nm) has been used to treat acne, because it has a toxic effect on the acne bacteria, Proprionibacterium acnes.The Excimer laser uses noble gas and halogen to produce ultraviolet radiation (308 nm) that will clear psoriasisplaques. However the small spot size and the tendency to cause blistering makes treatment time-consuming and difficult to perform.  

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Psoriasis Laser Treatment: How It Works

 Excimer laser treatments are performed in the dermatologist's office. Each session takes only a few minutes. During the treatment, the doctor aims the laser directly at patches of psoriasis. You might feel some warmth at the site or a snapping sensation against the skin.Excimer lasers aim a high intensity ultraviolet B (UVB) light dose of a very specific wavelength -- 308 nanometers -- directly at the psoriasis plaques. Because the laser light never touches the surrounding skin, it reduces the risk of UV radiation exposure. Excimer lasers are used to treat mild-to-moderate psoriasis.With excimer laser therapy, patients usually have 2 sessions a week for 4 to 10 sessions to get results. 

Your doctor will determine your dose of laser light based on the thickness of your psoriasis plaques and your skin color (a lower dose is used on lighter skin). During the procedure, you will be given dark goggles to protect your eyes. 

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What You Should Know Before Starting Laser Treatment

 Laser treatment for psoriasis can produce dramatic results in some people -- but this therapy isn't for everyone. To make sure you're a good candidate, have a complete health history and exam done before starting treatment.Avoid laser treatments if you have:

  • Lupus or scleroderma
  • Sun sensitivity
  • Xeroderma pigmentosum (an inherited disease that causes sensitivity to sunlight)
  • Risks for, or a history of, skin cancer
  • A condition that requires you to take medications that make you sensitive to the sun 

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Are There Any Risks to Laser Treatments for Psoriasis?

 Laser therapy is generally safe, but some people have reported side effects after treatment, including:

  • Temporary redness, itching, burning, and stinging
  • Blistering
  • Purple-colored spots (purpura) on the skin
  • Darkening or lightening of the skin (hyperpigmentation or hypopigmentation)
  • Scarring

More research is needed to determine whether exposure to UVB light from the excimer laser might increase the long-term risk for skin cancer 

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Laser safety

 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.

Adverse effects of laser

 Laser treatments are basically burns. The following effects may occur:

  • Temporary pain, redness, bruising, blistering and/or crusting
  • Infection, including reactivation of herpes simplex
  • Pigment changes (brown and white marks), which may be permanent
  • Scarring

References

 

  • Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol 2008;58:719-37. PubMed.
  • Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003;49:1-31. PubMed.
  • Cantatore JL, Kriegel DA. Laser surgery: an approach to the pediatric patient. J Am Acad Dermatol 2004;50:165-84. PubMed.

Dermal Fillers hyaluronic cosmetic injections

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Présentez vos services

 Since its approval in 1981, bovine collagen had been the only US Food and Drug Administration (FDA)–approved dermal filler more than a decade. Quickly, this dermal filler gained popularity and was marketed under the name Zyderm I. This dermal filler was found to be extremely effective for the correction of fine lines and shallow scars, with results often lasting 3 months.Moderate rhytides, deeper nasolabial folds, and marionette lines could be treated using Zyderm I with fair results, but results often did not last more than 2 months. What became clear is that Zyderm I had 3 major shortcomings: the potential for allergy to the bovine collagen, which required skin testing prior to the first treatment; results generally lasted 3 months or less; and disappointing results if used to fill moderate rhytides, skin folds, or scars.Two years later, Zyderm II and Zyplast were FDA approved and introduced into the market, to address the latter 2 shortcomings of Zyderm I. These newer dermal fillers, Zyplast in particular, significantly improved overall results for deeper rhytides and folds and these dermal fillers, for more than a decade, remained the only dermal fillers that were FDA approved for use in the United States. Despite this, the need for most patients to have frequent treatments, the need for new patients to undergo skin allergy testing prior to treatment, and the limitations of the treatment of deeper rhytides and folds, the full potential for dermal fillers was not seen until the recent addition of newer dermal fillers to the armamentarium.  The perfect dermal filler would be inexpensive, safe, painless to inject, hypoallergenic, and long lasting. In addition, it should have consistent and predictable results, feel natural under the skin, take little time to inject, be ready-to-use, exert no downtime on the patient, and have a low risk of complications. With the increasing desire for people to achieve a more youthful appearance, the aging baby boomer population, and the increased demand for "lunch-time procedures," the pharmaceutical market has responded by providing the cosmetic surgeon with an increasing number of options to meet the demands of the cosmetic patient. Thus, this segment of cosmetic surgery has been the fastest growing for the past decade.By definition, a dermal filler is a product that is injected or placed into the dermis. Patients are instructed to not manipulate the treated areas, because the product may shift. The best way to reduce inflammation is to immediately apply a cool pack to the areas that were treated. In current practice, several dermal fillers are available for use in the United States, in addition to subdermal fillers, or those that are placed underneath the dermis in the subcutis.This article primarily addresses the dermal fillers that are FDA approved for use in the United States. Nonanimal, animal, and synthetic dermal fillers are mentioned in the article. Cadaveric-derived dermal fillers and implants are not mentioned because they are costly, not all of them are FDA approved, and they are used more frequently for burn victims. 

Caution

 In May 2015, the FDA issued a warning to healthcare providers and the public about serious complications that can occur if dermal fillers are inadvertently injected into blood vessels in the face. The complications could possibly include vision impairment, blindness, stroke, and damage and/or necrosis of the skin and underlying facial structures. Caution should be used to ensure proper placement of the filler material, and patients should be informed about the potential adverse effects and how to recognize symptoms of impending serious complications. 

Juvederm Injectable Gel

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 Juvederm is a cosmetic filler intended to fill in facial wrinkles and folds. This hyaluronic-acid based filler replaces the hyaluronic acid lost by the body as part of the aging process. Hyaluronic acid is naturally found in the body’s connective tissue. Injections of Juvederm fill in the space between collagen and elastin in the skin. Once injected, it increases smoothness and volume while attracting water molecules to improve hydration. As a result, the appearance of fine lines and wrinkles is improved. 

 There are currently two formulations of Juvederm available for cosmetic injections. Juvederm Ultra is recommended for superficial facial wrinkles, while Juvederm Ultra Plus is a gel formulated to fill deeper folds and wrinkles. When compared with other hyaluronic acid-based cosmetic fillers such as Perlane, Prevelle Silk and Restylane Injections, Juvederm offers the highest available concentration of hyaluronic acid. It also has a smoother consistency, which some doctors feel leads to a more natural appearance. 

Zones of Treatment

 Most people choosing to undergo this treatment are 30 to 65 years old and are in good overall health. You should not have this treatment done if you are pregnant or breastfeeding; some medical conditions and medications may also make you ineligible for injections.  

  • Glabellar furrows (deep lines between the eyebrows)
  • Fine lines surrounding the eyes (crow’s feet)
  • Forehead lines or worry lines (horizontal wrinkles above the brow line)
  • Nasolabial folds (from the outer edges of the mouth to the nose)
  • Marionette lines (vertical lines running downwards from the edges of the mouth)
  • Plumping the lips (known as lip augmentation)

Treatment Details: What to Expect

 Injections take about 30 minutes in the doctor’s office. If desired, a local or topical anesthetic may be used. However, many patients experience only minor discomfort at the time of injection, and opt not to use any form of anesthesia. Juvederm can also be formulated with lidocaine, a local anesthetic, for a comfortable and pain-free experience. Using a thin needle, the doctor injects the gel underneath the skin, precisely targeting selected areas of the skin. Immediately following the injection session, patients are free to leave the doctor’s office and continue with their normal daily activities. 

Safety Information

 Juvederm is considered a safe, relatively non-invasive cosmetic treatment similar to other dermal fillers. Potential side effects include tenderness, redness, or minor bruising around the injection site. These side effects usually subside within a few days. Rarely, infection may occur. 

Recovery Time

 Patients can return to work immediately, and to strenuous exercise within 1-2 days. No bandages are required, and makeup can be work over the treated area as soon as the injection is done. The results will continue to improve over the next few weeks. As the gel attracts water and improves the structure of the skin, it leads to long-lasting results, which are maintained even as the gel itself is gradually broken down by the body. While some wrinkles will reappear at this time, many patients find that some residual effects of the  injections are still visible several years after treatment.  

Fotona Aesthetic Lasers

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Highest Performance Laser Systems

 With over 50 years of experience in laser technology, Fotona’s line of aesthetic lasers systems is leading the industry forward with new levels of innovation and performance. Fotona is recognized as a world leader in aesthetic applications and technologies, working closely with top universities and medical research centers around the globe.

Fotona manufactures the most advanced multi-application aesthetic laser system (SP Dynamis) and the highest single-pulse energy Q-switched laser on the aesthetic market (StarWalker).

Two Laser Wavelengths – All Major Applications

 Fotona was the first manufacturer to introduce two complementary laser wavelengths (Er:YAG and Nd:YAG) in a single system (Skinlight, 1994). Combining both wavelengths in a single treatment makes best use of the unique laser-tissue interaction characteristics of each laser wavelength, and can dramatically improve the outcome of laser-assisted treatments to achieve superior clinical results.Innovative solutions are available for a wide range of aesthetic treatments, including skin resurfacing & rejuvenation, veins and vascular lesions, pigmented lesions & tattoo removal, permanent hair reduction, and much more. 

Nd:YAG Lasers – For Treatment of Deep-Lying Structures

 Fotona's Nd:YAG laser light penetrates deeper into the skin to selectively target even the deepest skin structures such as deep-lying veins and hair follicles. The thermal energy of the laser heats them to a point where the desired effect is achieved. With Fotona's Q-switched technology, instead of heat, laser light is transformed into photoacoustic waves which mechanically break apart unwanted particles, such as pigments, so that the body’s own immune system can remove them. 

Er:YAG Lasers – For Treatment of Superficial Lesions

 Fotona’s Er:YAG laser wavelength targets the uppermost layer of skin, enabling extremely precise, micron layer-by-layer ablation of the epidermis. The energy of the laser is absorbed by the water content in the skin cells and the tissue can be vaporized. This causes the skin treated to shrink, stimulating the production of new collagen in the dermis. The overall result is that new skin forms which is smoother and tighter. VSP technology enables the practitioner to select various modes of operation, ranging from cold ablation to a combined ablative and thermal treatment, and even a completely thermal, non-ablative skin rejuvenation deep in the dermis. Fotona Er:YAG lasers thus provide the practitioner with the widest possible range of skin rejuvenation treatments (collagen remodeling, skin tightening, light peels, etc.). 

The Benefits of Fotona Lasers Include:

 

  • High-precision, tissue-selective treatments
  • Intuitive, easy-to-use parameter selection
  • Low cost of consumables
  • A haemostatic effect with simultaneous disinfection
  • Less invasive, safer treatments, and shorter downtime
  • Greater patient comfort and satisfaction

The Right Laser for Your Practice

 Fotona's wide range of aesthetic laser systems with multi-application platforms allow practitioners to select the product that best meets the needs of their patients.Fotona additionally offers individual Treatment Upgrade Kits, which provide Fotona laser users with the necessary knowledge, accessories and a complete set of tools to confidently and skillfully perform a certain procedure on their patients.