The CO2 laser was the first to show a significant clinical response in treating wrinkles and acne scars. The laser type and setting may be modified to target a specific lesion according to the tissue type, scattering pattern, and absorption spectrum. In general, lasers work by causing photothermolysis (the process of light amplification). The light is roped by a specific chromophore in the tissue, converting it to heat energy. Water, melanin, and oxyhemoglobin are the primary endogenous chromophore. Carbon particles from the colloidal charchol masked applied before the carbon peel procedure using the Lutronic spectra q-switch laser can also be used as exogenous chromophores.
The degree of laser absorption and, as a result, the heat produced is determined by the absorption spectrum of each chromophore. Another critical component is the penetration depth.; as the wavelength of the laser beam increases, the depth of penetration increases. The light scattering is inversely proportional to the depth of laser beam penetration. Only before the mid-infrared region of the light spectrum is this true. The longer the wavelength, the more light is absorbed by water, and the more superficial the laser becomes.
A medical aesthetician should know these fundamental concepts to choose the correct settings for the desired outcomes. In other words, if we’re going after a lesion like wrinkles or pigmentation, we need to get as close to the target absorption profile as possible. This will aid in delivering energy to the target tissue while preserving the surrounding tissues.
Thermal relaxation time is another important concept: the time it takes for the target to heat up and then release the heat to the surrounding tissue. Regardless of how precise the laser is, if we deliver energy to a target for a long time, the energy will be passed to the surrounding tissue. The laser pulse width addresses this concept. The period over which laser energy is delivered is known as the pulse width. The time is measured in milliseconds, nanoseconds, and picoseconds. Because the medical professional can control the pulse width, this concept is important in all treatments, especially hair removal (it is not the case with the nano and pico range). The pulse width must be shorter than the thermal relaxation time to give the target tissue a long enough break or cool down without damaging the surrounding tissue. On the other hand, a very short pulse width indicates that all laser energy will be delivered quickly, which is considered an aggressive treatment.
We must use a resurfacing laser to remove wrinkles, and there are two types: ablative and nonablative. Each of these lasers can be fractional or nonfractional. Ablative lasers, such as CO2 and ER: YAG, are the most aggressive laser treatments because they target water and vaporize the entire tissue. The fractional head is one way to team up with the beast. These heads will direct the laser beam to create specific treatment areas while leaving most of the surrounding tissues undamaged. The epithelium, papillary dermis, and reticular dermis are all destroyed using an ablative nonfractional laser. Collagen synthesis, tissue remodelling, and skin tightening occur as a result. The Er: Yag Fraxel laser emits a wavelength of 2940 nm, readily absorbed by water, resulting in superficial penetration. It has been proven that Er: YAG and CO2 have the same effect on acne scars, with the ER: YAG group experiencing fewer side effects. The most common side effect of using an ablative laser is post-inflammatory pigmentation (PIH). Research shows that using Hydroquinone 4 percent and tretinoin 1 percent for six weeks before laser treatment significantly reduced the risk. Skin tightening, scar removal, pigmentation removal, wrinkle removal, and acne treatment are the most common indications for fractional ablative and nonablative laser treatment. The nonablative laser has a lower affinity for water and is linked to better skin tightening, acne scar removal, and wrinkle removal with less downtime and side effects.
All nonablative lasers are suitable for patients with mild to moderate wrinkles, such as Glogau types I–III. Nonfractional lasers are best suited to patients willing to accept minor improvements and want short visits with little to no downtime after the procedure. Fractional lasers are appropriate for patients with mild to moderate wrinkles which are willing to accept some procedural discomfort and post-procedure downtime in exchange for a more dramatic reduction of wrinkles. Patients with severe wrinkles, especially those with significant skin laxity, are better candidates for ablative lasers or surgery. All nonablative laser technologies, including those with shorter wavelengths (e.g., 532 nm and pulsed dye lasers), may be used to treat light Fitzpatrick skin types (I– III), as these patients have a lower risk of complications such as burns.
Nonfractional lasers that target water can safely treat dark Fitzpatrick skin types (IV-VI). While darker skin types can benefit from fractional lasers that target water, these technologies carry a higher risk of pigmentary changes and may require more conservative settings, reducing results. Expectations of Patients To achieve visible results with nonablative lasers, treatments must be performed at monthly intervals: 4– 6 for fractional lasers and 6– 8 for nonfractional lasers. Compared to ablative lasers, the results of nonablative resurfacing treatments (even in a series) are slow and subtle. To ensure treatment success, it is critical to assess patients’ expectations during the consultation and commit to a series of treatments. Mild wrinkle reduction is achieved with nonfractional lasers that target water, melanin, and oxyhemoglobin. Results are usually visible 2–3 months after the initial laser treatment, and improvements can last six months. Skin resurfacing effects are less dramatic when compared to fractional nonablative lasers.
On the other hand, these treatments have the benefit of requiring little to no recovery time, lowering the risk of complications, and being simple to incorporate into patients’ daily lives. Water-targeting fractional lasers produce faster and more significant results than nonfractional lasers. Results are usually visible one month after treatment, and improvements can last up to 6 months with nonfractional lasers. These laser treatments are more painful than nonablative ones, and they usually require a topical anesthetic before the procedure and forced-air cooling during the procedure to be comfortable. Some patients need oral analgesics and anxiolytics. Post-procedure erythema and edema typically last 3–4 days, and procedures can cause complications like pigmentary changes, acne flare-ups, and milia formation.
• Mild static rhytids • Rough skin texture • Enlarged pores • Acne scars on the surface • Moderate static rhytids • Benign pigmented lesions (e.g., lentigines, ephelides) • Melasma • Scarring (atrophic and hypertrophic) • Striae • Actinic keratoses • Hypopigmentation • Poikiloderma of Civatte • Telangiectasias and erythema • Telangiectasias and erythema
The gold standard for skin resurfacing is ablative lasers (e.g., carbon dioxide and erbium lasers). These more aggressive, deeper skin resurfacing procedures have a better chance of reducing static wrinkles, but they take longer to recover from and have a higher risk of complications. Although fractional lasers have a faster recovery time and a lower risk of complications, ablative laser treatments, whether fractional or nonfractional, leave an open wound that can lead to scarring and infection. Skin resurfacing with light chemical peels or microdermabrasion and topical skincare products like retinoids and exfoliants are non-laser options for wrinkle reduction (e.g., hydroxy acids). Deeper chemical peels (e.g., phenol) and dermabrasion, which uses a motorized rotating wire-bristle brush to irritate the skin, have traditionally been used for more aggressive skin resurfacing, but these higher-risk procedures are no longer used. Botulinum toxin for dynamic wrinkles and dermal fillers for static lines are two other treatments for facial lines and wrinkles frequently used in conjunction with laser procedures. Surgery is an option for severe wrinkling with saggy, lax skin. LEDs emit narrow, low-intensity wavelengths that do not cause epidermal or dermal damage. While these light-based devices resemble lasers and other light-based technologies, their results are limited nd only briefly discussed here. Red light LED devices (570– 670 nm) have been used for mild wrinkle reduction, and blue light LED devices (400– 500 nm) have been used for acne. They don’t work based on selective photothermolysis but on the principle of photo modulation, which regulates cellular activity by exposing it to specific wavelengths of light. The main benefit of LEDs is their simplicity. Radiofrequency technologies are used to treat wrinkles and reduce skin laxity and folds. Skin tightening is a term used by the United States Food and Drug Administration (FDA) to describe the reduction of skin laxity and folds to improve skin contour. When applied to the skin, radiofrequency devices (such as Thermage ® and Solta) use a rapidly alternating current that generates heat due to the skin’s resistance to current flow. Several factors influence tissue heating with radiofrequency devices, including the type of electrodes used (monopolar or bipolar), fluency, and cooling times. The periocular region, nasolabial folds, jowls, neck, and abdomen have all been shown to improve laxity with these technologies. Fractional resurfacing is now done with newer radiofrequency devices (e.g., Syneron’s Matrix RF TM and Lutronic’s Infini TM). Fractional RF devices concentrate heat in the mid to deep dermis with minimal epidermal disruption, earning them the moniker “sublative” devices.
Don’t hesitate to contact us if you have questions about your skincare; we are Edmonton’s most advanced cosmetic and laser clinic. Skin tightening, wrinkle removal, acne scar removal, acne treatment, scar removal, stretch mark removal, pigmentation removal, melasma treatment, freckles and sunspots treatment, body shaping, fat reduction, body slimming, coolsculpting, and sculpsure are all procedures we have extensive experience with.