Since its invention by American physicist Dr. Theodore Harold Maiman in 1960, laser technology has been revolutionizing not only the field of medicine and dermatology, but also other processes in industry, electronics, data processing, communications and scientific research.
Before its discovery, however, laser was popularized in novels and movies as a weapon of destruction. Now, it has myriad of uses, foremost of which is that it serves as a potent and effective instrument for curing and healing ailments and diseases.
It is interesting to note that dermatologists were among the first in the medical world to use lasers. They seized it as a tool for treating skin problems such as unsightly moles, freckles, tattoos, scars, wrinkles and birthmarks.
With this technology, it has now become possible to get rid of some of these skin conditions without going under the knife, thus minimizing the risk of infection, the degree of bleeding, swelling and pain, and eliminating the need for general anesthesia.
These advantages have made laser treatment an increasingly appealing option for patients. A sign of the emerging popularity of laser treatments is the fact that lasers can now be found not only in hospitals and skin clinics but even in spas and beauty centers.
Furthermore, we are bombarded with so many ads of lasers, genuine or otherwise. In extreme cases there has been an abuse of the word laser by some establishments that advertise any form of light-emitting equipment as a laser in order to draw in clients.
As the quest for the perfect body and the flawless face continues, the Philippine Dermatological Society (PDS) seeks to make the necessary clarifications regarding laser treatments in order to enlighten the general public and assist potential patients in making an informed decision.
The beam’s color differs for each laser, depending on the substance put inside the laser chamber. When activated, the chamber emits a specific light with a corresponding wavelength, which breaks down, dissolves or destroys a specific target, with minimal damage to surrounding structures.
In addition to laser, dermatologists also use a similar technique, known as "Intense Pulsed Light" or IPL. It differs from laser, as it is made up of a blend of various wavelengths emitted by a flashlamp.
IPL beams a gentler and more diffused energy, which is absorbed by various skin components, creating a full and subtle improvement, particularly of photo-damaged skin.
There is no single laser that can target and remedy all skin conditions. Each condition has a specific laser employed – as in vascular laser, pigment laser, hair removal laser, epidermal resurfacing laser, and sub-surfacing or non-ablative laser.
Vascular birthmarks such as hemangiomas and port-wine stains, and spider veins are eradicated using the pulsed dye laser, which targets the hemoglobin.
Tattoos, age spots, freckles and some pigmented birthmarks can be lightened with melanin-specific, short-pulse and high energy, Q-switched Nd:YAG laser.
Permanent hair reduction is best accomplished with long-pulsed lasers such as alexandrite, diode and Nd:YAG.
Wrinkles, photo-damaged skin and depressed scars due to acne or chickenpox may be improved with resurfacing lasers such as short-pulsed carbon dioxide and erbium-YAG laser. The newer subsurfacing lasers such as long-pulsed diode, Nd:YAG and infrared lasers offer less downtime.
Lasers could also treat keloids and hypertrophic scars, warts, psoriasis, acne and some skin tumors.
IPL is best used for photo-rejuvenation, and in eliminating age spots, redness and large pores.
In fact, in the United States, where the skin laser treatment industry is now a $2-billion-a-year business, complaints are cropping up, with a number of patients being injured by laser treatments done in spas and beauty salons by individuals with inadequate training, the PDS reported.
It is therefore highly advisable that before undergoing any laser treatment, interested persons should first consult a board-certified dermatologist. The dermatologist, after thoroughly evaluating the patient, will give the proper diagnosis and discuss all the treatment options available. If laser is the ideal treatment, the dermatologist will also discuss what the patient should expect from the treatment and any possible complications.
The patient should not be afraid to ask questions and to check the credentials of the person who will be performing the treatment. That person should not merely be able to operate the laser machine but should also know which laser would be best suited for a particular skin problem and a particular skin type. Keep in mind, too, that not all establishments with the latest laser equipment will also have the qualified people to use these machines.
Multiple sessions are usually required, and improvement may not be 100 percent or permanent for some skin conditions.
At least two to four weeks before treatment, PDS advises that patients should avoid tanning – be it obtained naturally through sunbathing or artificially in beauty parlors – as it increases the risk of darkening and burning.
The time spent for actual treatment depends on the type of laser or IPL used, and the extent of skin to be treated.
For instance, facial photo-rejuvenation via IPL can be done in just an hour, or during lunch break. Right after treatment, the patient can immediately work, as if nothing happened. Removing unwanted hair is also quick.
Vascular and pigment laser treatments, however, take longer. One hour before treatment, a cream is applied to numb the skin.
The longest treatment is the carbon dioxide resurfacing laser, as it entails administering anesthesia and possibly, sedation. Thereafter, it takes two weeks to heal the raw skin. After the skin heals, there will be some redness for about six months, when strict sun avoidance is advised, especially for dark-skinned and tanned individuals.
Pigment lasers may also cause darkening of the treated skin. However, it is often temporary, lasting three to four months. The reverse is also true – that is, treatment with pigment lasers can also cause hypopigmentation.
In dark-skinned patients, blisters may occur due to excessive absorption of laser beam by the target (usually melanin), but it usually heals within a week or two.
Further, bruising due to leakage of red blood cells from zapped vessels, which may occur with the use of vascular lasers, usually disappears within a few weeks.
Major complications include infections, second and third degree burns and scarring. However, in the hands of a properly trained physician, these complications are rare.
In all, the PDS noted, the ideal person to perform IPL or laser treatment for skin problems is a doctor who is board-certified in dermatology, or another specialty with equivalent training. He or she should have at least three years of residency in a reputable medical center, where he or she has been exposed to a variety of skin problems and has passed a rigorous specialty board examination.
In addition, he or she should have undergone further training in laser surgery, and familiar with the different types of laser machines, their indications and proper usage. As not all skin disorders can be treated with laser or IPL, the dermatologist should therefore use them only when they are the best or only option.
It is committed to maintain the highest professional ethical standards in the practice of dermatology through its mission-vision: to be a highly recognized society, locally and globally, striving toward excellence in the attainment of healthy skin for all, through humane service, information dissemination, training and research.
The PDS Secretariat is at Rm. 1015, Front Tower, Cathedral Heights Building Complex, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, 727-7309; www.pds.org.ph