Once the domain of celebrities (or sci-fi movies!), lasers are now among the most common dermatological procedures in the world. But as lasers (quick trivia: "laser" stands for light amplification by stimulated emission of radiation) increase in popularity, they're becoming not just better and more diverse, but also a lot harder to keep track of. All lasers are not created equal -- or designed to treat the same skin concerns. Let's look at a few of the most popular to help you decide which, if any, are right for you:
Wrinkle, Scar, and Stretch Mark Removal
- What it treats: First introduced in the late '60s, the CO2 laser is still around and sometimes used skin rejuvenation. It is an option for all-over resurfacing to improve skin's evenness and smooth stubborn wrinkles. It is not used very often because it had the side effects of long healing times (pink for up to 6 months) and could result in decreased skin color in the treated areas. Its use has largely been replaced with "fractional" mode lasers that only treat “fractions” or small areas of the skin as if in a grid. This new technology allows for faster healing, less discomfort, and fewer side effects. (See Fraxel below)
- How it works: The CO2 laser is what's known as an “ablative laser”, meaning that, unlike many of the other lasers on this list, it cannot selectively treat the skin. Any areas of skin it is passed over are, essentially, burned. The result, though, is a new layer of healthier and more evenly pigmented skin cells.
- The details: Because ablative lasers temporarily remove part of the epidermis, they require considerably more recovery time than non-ablative lasers. Those with dark skin should not use these lasers. Healing can take months with the older CO2 lasers and may take 7-14 days when using the fractional CO2 lasers.
What it treats: The Pearl is ideal for improving skin's texture and minimizing surface lines and wrinkles on the face, neck, and chest. I love it for treating aged hands too -- they often give away a person's age more than any other part of the body!
- How it works: Like the CO2 laser, the Pearl is an ablative laser. It uses a new wavelength, though, that can penetrate deeper than traditional ablative lasers. This deeper penetration leads to collagen production in the dermis while also treating imperfections in the epidermis.
- The details: Patients typically experience minimal redness for 3-4 days after treatment. One treatment is sufficient for many people, although more dramatic resurfacing may require two sessions. Treatment is fast (about 15-20 minutes for the average session) and produces results quickly (the same 3-4 days it takes for redness to heal), but can cost around $1500.
Fraxel (Reliant Technologies)
What it treats: The Fraxel is excellent for both improving skin's texture through collagen generation and evening the complexion by destroying unevenly pigmented surface cells. It has been used -- with great results -- to minimize acne scars, improve hyperpigmentation, smooth the skin on the neck and face, and tackle crepey eyelids. The laser has largely replaced the traditional CO2 laser and is one of the most popular lasers in the US.
How it works: The Fraxel laser takes its name from its "fractional" approach -- it treats thousands of tiny but deep columns all the way down to the dermis. In so doing, the Fraxel destroys pigmented skin cells in the epidermis while stimulating your skin's natural healing processes to generate healthy new ones. Equally important, though, is what the Fraxel doesn't do: Working on microscopic zones allows it to leave surrounding healthy skin untouched, thus minimizing downtime.
The details: To see optimal results from the Fraxel, you may need anywhere from 3-6 sessions. While costs vary quite a bit depending on the area to be treated, each session can cost up to $1,200. (A package of 3 is usually $3000) Downtime following this procedure is minimal, with 1-2 days of redness followed by 1-2 days of mild peeling or dryness. Patients typically return to work after 48 hours or less.
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- What it treats: Hair removal offers a great example of how far laser technology has come in recent years, as our current laser hair removal options are far more effective than past systems. Depending on the hair color and texture, and the patient's skin color, diode lasers, Nd: YAG, or the Alexandrite laser may be used. And now even those with dark skin can get laser hair removal (which wasn't always the case) -- the Cool Glide laser by Cutera works on black skin. Lasers can treat excess hair anywhere on the body.
- How it works: While several different lasers can be used to minimize excess hair, they all work roughly the same way: A beam of light targets the hair shaft to hinder the follicle's ability to produce new cells.
- The details: Patients may experience some redness or irritation after treatment, but the downtime following laser hair removal is generally minimal. Depending on the amount of hair in question, 3-6 treatments are usually required for optimal results, at approximately $400-500 per treatment.
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Tightening Sagging Skin
- What it treats: The Titan can, well, tighten skin almost anywhere on the body: I've seen it used with great success on the jaw line, tummy, and backs of the arms, and it's a wonderful option for sagging skin on the elbows and knees (which were previously untreatable). I see many patients who've neglected their necks and paid the price, but the Titan can even restore the neck's youthful appearance.
- How it works: Using infrared light, the Titan laser heats the dermis, causing existing collagen to contract and new collagen to begin forming. Because the laser features a special cool tip, the epidermis is protected throughout treatment.
- The details: Unlike many other lasers, the Titan is safe for use on dark skin. Treatment plans vary according to the area of the body and degree of skin sagging, but optimal results usually require treatments once a month for three months, at approximately $600 per treatment. Any minimal redness that occurs typically clears up within minutes to hours.
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Erasing Broken Blood Vessels & Improving Facial Redness
Vascular Lasers (i.e. pulse dye lasers,
the Nd:Yag, V-Beam)
- What they treat: This is a general term for lasers that are used primarily for treating minor disorders of the veins like spider veins and the dilated blood vessels associated with rosacea. They can also be helpful in the treatment of flushing, birthmarks, and even red scars and red/purple stretch marks.
- How they work: These devices work by selective photothermolysis- the process by which a laser's wavelength can be set to destroy one specific color, like the melanin in a sun spot or the redness of a broken blood vessel. It leaves anything not that color untouched. For this reason, you can laser broken blood vessels while leaving normal surrounding skin untouched.
- The details: Each treatment with these devices can cost anywhere from $200-600. The bruising they cause should clear up within 10 days of treatment.
940nm Diode Laser
- What it treats: The 940nm diode laser is particularly effective in treating broken blood vessels. These include the veins around the nose. It also treats blue veins that can be seen as blue lumps on the lips and cherry angiomas which are red moles that form on the skin. What sets this laser apart is that it leaves no bruising, so you can go about your normal routine right away.
- How it works: The 940nm diode laser works by a process called selective photothermolysis. That means that the energy it produces is selectively absorbed by certain colors, like those of sun spots or spider veins. Set to the proper wavelength, the laser heats up and destroys only the targeted cells while leaving normal, healthy skin cells untouched.
- The details: Virtually painless (the sensation has been compared a light snap from a rubber band), the 940nm laser requires no downtime, as it produces no redness or bruising. One treatment -- which typically costs around $500 and takes only a few minutes -- is often all that's required to tackle visible veins on the face, red moles and blue veins on the lips and face.
* The following devices, though not technically lasers, are so often included in
discussions of laser procedures that I'm tackling 'em here:
IPL (Intense Pulsed Light)
- What it treats: If a complexion is uneven, chances are good that IPL can treat it. IPL devices (there quite a few on the market, but the Quantum by Lumenis is my favorite) have been very successful in eliminating the redness and flushing associated with acne, rosacea, and broken blood vessels, as well as hyperpigmentation like sun spots. This device evens your skin tone and makes skin radiant. It may temporarily help shrink pores. IPL may also be used for hair removal or the treatment of keratosis pilaris (tiny red bumps that typically appear on the upper arms or inner thighs). One word of caution: While I believe IPL will eventually be harnessed for the treatment of wrinkles, it's not very effective in that department just yet -- if that's your concern, try another type of laser.
- How it works: IPL systems, versus true lasers, offer the benefits of adjustable light wavelengths. That is, they can be used to treat various types of discoloration at once. As the IPL device produces short bursts of light, it destroys the hyperpigmented skin cell, dilated veins, or hair follicle in question.
- The details: IPL devices cannot be used on very dark skin. Treatments, which last about 15 minutes, are typically repeated once a month for 3-5 months, or until optimal results are achieved. The skin may be slightly pink (like a sunburn) for 2 days after treatment. Hyperpigmented (brown) areas may get darker for 4 days and then will peel off. Although it varies by areas treated, each session generally costs about $500.
LED (Light Emitting Diodes)
- What it treats: LED treatments are the latest tool in the treatment of acne, and have been highly successful in controlling breakouts that oral and topical medications have failed to curb. They may also be an attractive alternative to stronger treatment options like Accutane. LED treatments can also help wounds heal or improve hyperpigmentation, although for those indications, LED's results are generally less dramatic than some of the other procedures on this list.
- How it works: LED devices work by the process of photomodulation -- that is, they change cells' activity rather than destroying them completely. Using various wavelengths (blue or red light is used to treat acne, for example), LED treatments can kill acne-causing bacteria in skin cells or reduce inflammation.
- The details: LED treatments -- which cost around $75 per visit -- last about 15 minutes, are painless, and require no downtime. The number of treatments required will vary according to the severity of your acne and the other elements of your blemish-control regimen.
Just one final point: While these treatments become more effective and affordable every day, they are still medical treatments. Getting the best results -- and avoiding undesirable side effects -- means going to the best doctor. Do not get these done in a salon or spa because they are not allowed to use the same amount of power that a physician can and the results are not as effective. Make sure anyone who performs a laser treatment on you is qualified to do so.
For more details see a recent New York Times article that discusses various lasers by clicking here.
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Q: I read something about "Levulan," but now I can't remember what it treats. Is that a professional procedure?
A: No, but it may be used during a professional light treatment. Levulan is a topical photosensitizing agent that can make light treatments (like IPL, pulsed dye lasers, and LED devices) more effective. Levulan contains the active ingredient aminolevulinic acid, which makes skin cells very sensitive to light. First the Levulan (in a liquid form) is applied to the desire areas. Once it has been absorbed and the light device is turned on, the targeted cells (those that are hyperpigmented or acne-prone or even precancerous, for example) are destroyed faster and more effectively than they would have been without Levulan. Be aware, though, that increased effectiveness comes with increased downtime -- skin may be red for up to four days after IPL, for example, versus about two days without Levulan.
For more information about these lasers, come visit us at the The University of Miami Cosmetic Group. For appointments call 305-532-5552.
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Wishing you great skin!
Dr. Joely Kaufman
Dr. Leslie Baumann
Do you have a question? Come visit me at www.SkinTypeSolutions.com or
read my Yahoo blog at www.SkinGuru.com
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