Lasers, Intense Pulsed Light, and LEDs

Dr. Kenneth Rothaus understands the importance and use of cosmetic lasers, intense pulse light devices, plasma devices, and LEDs in an aesthetic practice. Dr. Rothaus knows that one aesthetic light device cannot be used for all problems and diagnoses. Therefore, he has amassed in his office a full line of aesthetic lasers, intense pulse light devices, LEDs and low level light lasers creating one of the most complete laser centers in a plastic surgeon's office in the New York City area and beyond.

The tools available to the aesthetic surgeon for rejuvenation of their patients include the use of light and plasma devices, as well as topical preparations. The light devices that are employed include:

1. Lasers
2. Intense Pulsed Light Devices
3. Light Emitting Diodes
4. Low Level Light Lasers

When patients come to see Dr. Kenneth Rothaus, the most frequently asked questions regarding laser treatment are:

What is a laser and how is an intense pulsed light device different?

The word LASER is itself an acronym for: Light Amplification by Stimulated Emission of Radiation. This just refers to the mechanics that happens inside the laser box to produce the laser light. The name of each type of laser refers to the element or substance in the box from which the light emanates.

Laser light has three unique characteristics:

1. It is monochromatic.  This means that it includes only one of the wavelengths of the electromagnetic spectrum.
2. It is coherent; that is, all the waves of light are in synchronization.  They each reach their high and low points at the same time.
3. The light waves are collimated, or perfectly parallel and never spread out.

Let us follow, for example, what happens in a carbon dioxide (C02) laser during a resurfacing procedure. When the laser is operating, a form of energy, which in this case is electricity, is used to excite the carbon dioxide in the tube. One of the "rules of physics" is that a substance will not normally remain in an excited state. When the carbon dioxide returns to its non-excited (resting) state, it gives off energy in the form of light. Inside the tube, there is a series of mirrors and filters that ensure that the light that comes out of the tube and the box meet the three previously described characteristics. The light is coherent, collimated and monochromatic.

1. Polychromatic (more than one wavelength)
2. Not collimated
3. Not coherent

Are LEDs and low level light lasers different from lasers and intense pulsed light devices?

An LED (light emitting diode) is a source of a low level light that is being used for a multitude of purposes (some of which are investigational), including reduction of inflammation, correction of hyperpigmentation, reduction in the appearance of spider veins and rosacea, improvement in texture and lines, reduction of wrinkles, acne control, and hair re-growth.

Low-level light lasers are lasers but of much lower energy and are being used for many of the same areas as described for LEDs, as well as for possible cellulite reduction.

How does it work?

There are many different lasers and intense pulse light devices. Each laser, or intense pulse light device, can be used to treat a specific problem. The laser used to treat your wrinkles is probably not the best laser to treat your varicose veins. The laser light is absorbed by the skin, hair, blood vessel, tattoo, or whatever else is being treated. The energy in the laser light is converted to heat. The heat that is produced will alter, cauterize or ablate the target tissues.

This is similar to what happens to your car in the summer. The sunlight is absorbed by the car's seats, and they become hot. Similarly, the laser light is absorbed by the tissues and is converted into heat. It is this heat that results in the final action. For example, when a laser is used to treat spider veins, the laser surgeon will choose a laser that is absorbed by hemoglobin, a substance found in all red blood cells. The heat produced will then damage the blood vessels so that they constrict.

What are the layers of the skin?

The skin is composed of two layers. The more superficial is called the epidermis and the deeper the dermis. The dermis is composed of the deeper reticular dermis and the more superficial papillary dermis. Laser surgeons refer to the border between the dermis and epidermis as the DE junction. Similarly, the border between the two layers of the dermis is referred to as the papillary reticular junction.

What is the Fitzpatrick Classification?

The Fitzpatrick Classification divides skin types into 6 categories based upon their reaction to the sun.

A Fitzpatrick I skin type is a fair skin, fair haired, blue eye person who always burns and never tans when exposed to the sun. A Fitzpatrick VI patient, on the other hand, has dark skin and never burns.  Fitzpatrick II - rarely tans, usually burns; Fitzpatrick III - usually tans, sometimes burns; Fitzpatrick IV - usually tans, rarely burns; and Fitzpatrick V - always tans, very rarely burns.

What is non-ablative resurfacing?

Non-ablative resurfacing refers to the treatment of skin, usually of the face, where the overlying epidermis is left intact. Treatment of pigment, collagen, vessels and even fat below the epidermis is referred to as non-ablative resurfacing.

What is ablative resurfacing?

In ablative resurfacing, the epidermis is removed and exposes the underlying dermis. This creates a wound that the body has to heal in order to restore the epidermal layer.

What is fractional resurfacing?

Fractional resurfacing is a process in which the epidermis, dermis, entire thickness of the skin, or the subcutaneous tissues are "lasered," creating dots or columns of treated tissue surrounded by tissue which has not been treated. This polka dot pattern of treatment allows the treatment depth to go deeper because the laser wound is healed rapidly due to the surrounding "normal" tissue.

Fractional resurfacing can be either ablative or non-ablative. It can be used for wrinkle reduction, treatment of pigmentation and texture, and skin tightening.

What is plasma skin resurfacing?

Plasma skin resurfacing is a new technology that does not use light, it instead harnesses similar energy found in the sun to improve the texture and pigmentation of the skin, reduce wrinkles and tighten the skin. Plasma is the fourth state of matter (in addition to solid, liquid and gas) and represents a superheated version of gas. For the Portrait device, the gas is nitrogen. Plasma skin resurfacing is considered a non-ablative form of resurfacing because the epidermis is left intact after the procedure, acts as a protective biological dressing as new epidermis is formed, and gently flakes off after a period of 4 to 7 days.