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Laser Treatments

Better Skin – at the Speed of Light


CosmeticSurgery.com Staff Report
Medically reviewed by: Darshan Shah, M.D.

Lasers and light therapies are giving consumers far more options in cosmetic surgery. But the field is an embarrassment of riches, because so many light-based therapy machines and lasers have come into use in surgical rejuvenation. Thus, consumers of cosmetic surgery are confused by the proliferation and which laser does what and for whom.

When registered nurse Sandie Harvey of Henderson, Las Vegas, turned 50, she had just gone through a divorce and finally received a clean bill of health after a long battle with cancer. But when she looked in the mirror, she saw a face staring back that bespoke a run-down person.

"I felt like my face was about as smooth as burlap," Sandie told CosmeticSurgery.com. "I had age and sun spots, crow's feet and acne scars." Because her job involved meeting and greeting existing and potential clients in the office of a plastic surgeon, Sandie felt she wasn't turning her best face forward. "If you're depressed about the way you look, you're not living life to its fullest," Sandy says. "After surviving cancer, I wanted to enjoy every minute and I also wanted to look like I'm in my 30s."

50, the New 40

Facial Laser Surgery
Two years later, Sandie had five laser treatments to smooth the skin on her face and one for her neck. Several months later, she attended a meeting with executives from the company that makes the lasers used in her treatment. Outcome? She made such a big impression, Sandie's picture and story now appear on the company's website. Plus, she was hired as a spokesperson for a campaign guaranteed to swell the pride of any person just past the half-century mark. The campaign? "Make 50 the New 40."

More people are turning to lasers, one of the the most high-tech areas of cosmetic and plastic surgery. Those patients, like Sandie, are often bothered by their wrinkles, skin discolorations, brown and age spots, growths, scars, tattoos, birthmarks and spider veins. Lasers are flashing to the rescue to treat a variety of cosmetic and medical conditions from head to toe with no needles, scalpels or stitches required. Just look at the trend:

According to the American Society of Aesthetic Plastic Surgeons (A.S.A.P.S.) laser hair removal, is the nation's second most frequently requested service, with an estimated 1.4 million patients having undergone the procedure in 2004. Moreover, The American Society for Dermatologic Surgery, which also does laser procedures on skin, counts five million various laser procedures performed in 2005. The rub is, no single laser can treat all conditions.

Colors of the Rainbow

And, given the many different types of laser and light therapy machines, anybody would be confused about which laser is supposed to do what in rejuvenation surgery. Dozens are available including those that seemingly use the colors of the rainbow along with infrared, radiofrequencies and other light-based technologies.

Facial Laser Surgery
In fact, actual laser names muddy the waters even more with a bewildering array of alphabet soup monikers like YAG, Ruby Red, Q-switched Alexandrite, erbium, yellow-pulsed dye, Argon and CO2 lasers. Other light-based treatments include V-beam, Smoothbeam, VelaSmooth, Titan, Fraxel, Thermage, Thermacool and, more recently, Aluma Laser.

But whatever the gizmo, lasers in the hands of surgeons during the last decade have changed the face of cosmetic surgery by making it easier and quicker to buff out blemishes and other signs of aging on faces, necks and hands. Plus, the devices cause relatively little bleeding. The surgeon never touches the cutting edge so chances for infection are reduced to almost nil. So what, exactly, do surgeons use lasers for?

In addition to removing hair, lasers take off skin by vaporizing it while some light-based treatments treat deeper tissues to make the overlying skin tighter. That happens because a beam of light can be adjusted to only slightly injure the tissues under your skin. When those tissues heal, they become tighter and remove some facial or bodily sagging by creating more collagen, the most common building block in the body. Common examples of that type of laser are the Titan, Thermage and Aluma Laser.

Lasers are also excellent for removing the blood vessels that cause spider and varicose veins, rosacea and other telangiectasias - areas where blood vessels create problems by showing through the skin.

Up in Smoke

Additionally, lasers can zap unwanted tattoos into nothingness because the clever machines can also be adjusted to react only with the color blue. Thus, the beam of light passes through skin and is absorbed by the blue in the ink…which goes up in smoke. Experts say the attraction of lasers, when used for facial procedures, are: no need for the patient to be put to sleep; shorter procedures in the office and a quicker return to normal activities with no, or little, recovery time. However, depending on the procedure, you must return for three to eight treatments which may take several months to a year for the effects to show.

"The gold standard for facial skin resurfacing and rejuvenation is the CO2 laser," says Mauro Romita, M.D., medical director and owner of The Ajune Center for Beauty Synergy in New York City. "The laser can make an aged face look ten to 12 years younger while removing blemishes and spots."

A CO2 laser can also be used as a scalpel, according to Brooke R. Seckel, M.D., an assistant professor of surgery at Harvard Medical School. "One millimeter is the width of a pencil line," says Dr. Seckel. "But a laser scalpel makes an incision only .2 mm wide which makes it the perfect instrument for areas of thin skin like on upper eyelids." Using a scalpel requires an operation of about one and one-half hours because the bleeding obscures the very small eyelid muscles, says Dr. Seckel. But the same operation with a laser takes 20 to 25 minutes because the laser seals blood vessels as it works. "A laser also puts no pressure on the skin, so there is less bruising," Dr. Seckel says.

When Sandie Harvey had one of the newer laser devices -- known as a Fraxel -- applied to her face, it slowly removed the marred layer of skin during the course of five treatments. A Fraxel works like an older, more powerful laser - by vaporizing the skin - but it has a doohickey that puts the beam of destructive light on only about 20 percent of the skin. So a dot-sized area of lased skin sits right next to a tiny area of untreated skin. The practitioner first applies a blue dye to the patient's skin and then a topical anesthetic to numb the skin. However, it can take some months for the results to show. The downside of any new laser whatchamacallit, according to one surgeon, is the expense and learning curve attached to each new machine.

Lasing Tomatoes and Chicken Skin

"Every time a new laser comes onto the market, the surgeon must not only buy very expensive equipment but master its use by lasing tomatoes and chicken skin," says Robert. Kotler, M.D., a plastic surgeon in private practice, a University of California faculty member and author of "Secrets of a Beverly Hills Cosmetic Surgeon" and other books. "Both of those items drive up the prices consumers must pay."

Other experts say consumers read about new devices - thanks to huge marketing budgets that place stories in the news media - and routinely expect their surgeons to have the latest laser gizmos, even if they are not used very often. Here's a quick look at where lasers may be used in cosmetic surgery:

The Head

Bald or shaved heads are at higher risk of sun damage and development of pre-cancerous lesions known as actinic keratoses. Laser operators often use photodynamic therapy to get rid of the diseased skin cells. That therapy requires a topical substance that absorbs laser light.

The Face

The most current treatment for acne is a laser that zaps bacterial production and shrinks overactive oil producing glands. A technology known as pulsed light therapy and LED therapy reduces fine lines, irregular skin texture and early signs of aging. A laser does the same job as a chemical peel - it resurfaces deeper layers of skin to allow fresher, younger looking skin to grow back.

Neck

Radiofrequency based technology heats deeper tissues to tighten and contour laxer skin when jowls start to droop. Some machines have thingamagigs to cool the surface of your skin as they heat the deeper tissues.

Décolletage and Shoulders

If you've been in the sun too much, the skin on your chest can turn crepey with brown spots. Non-destructive lasers and intense pulse light machines can remove the blotchiness and freckles while stimulating collagen to grow smoother skin. For tattoo removal, the most common machine is the Q-Switched Yag laser.

Torso

Port wine stains or other birthmarks, moles, age and sun spots can appear anywhere on the body. Several lasers and light systems treat these areas with the most common being the Intense Pulse Light (I.P.L.) device. Moreover, infrared laser therapy is being used with some success to break down body fat. While it is controversial and largely unproven, some practitioners claim they can reduce cellulite with a VelaSmooth, a machine that combines a non-destructive laser, radiofrequency and mechanical manipulation that shakes the flab.

Legs

Laser Surgery
While lasers are already the ultimate weapon for unwanted hair, consumers should ask their practitioners if the laser in use is appropriate for their particular hair color and skin type. The perfect candidate has very dark hair on very light skin. But for darker skin, things get dicier and burns may be more of a risk. Lasers used on spider and varicose veins actually remove the unsightly blemishes by heating the inside of the veins. The most common is the YAG laser.

Three Questions to Ask a Laser Practitioner

  1. Where have you trained and do you own or rent the laser equipment? (Surgeons who own have probably made more of a commitment to training and to continuing education in laser surgery.)
  2. May I see your before and after pictures of previous laser cases? (If a cosmetic surgeon doesn't want to show you the pictures, it's usually because he or she doesn't have any. That means he is inexperienced.)
  3. How many types of lasers do you own and how often is each piece used? (No one laser does everything so you want to select a surgeon whose practice offers more than one laser system. Some physicians own and operate as many as ten different lasers.)




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