LASERS AND OTHER LIGHT-BASED DEVICES IN DERMATOLOGY

How laser effectively treats various skin conditions

Definition & Mechanism of Action

The word laser stands for ‘Light Amplification by the Stimulated Emission of Radiation’. According to consultant dermatologist of Prince Court Medical Centre, Dr. Gangaram Hemandas, the word laser is also commonly referred to as the machine/device.
Lasers work by producing a specific wavelength of high intensity light which is absorbed by a specific structure in the skin, usually water, melanin or oxyhaemoglobin (found in red blood cells). “Once light energy is absorbed, it is converted to heat which then selectively destroys the target (certain cells in the unwanted lesion), without damaging the surrounding skin structures,” he says.

Benefits of Laser Treatment

• Non- or minimally-invasive and relatively bloodless
• Allows precise control of procedure, hence limiting injury to skin
• Day procedure
• Treats various skin problems
• Safe and effective and reduces risk of infection
• Less painful and scarring than traditional scalpel surgery

Uses of Lasers

There are various uses of lasers, including:

1. Removal of ‘lumps’ & ‘bumps’ and scars and wrinkles

Dr. Gangaram states that the carbon dioxide (CO2) laser emits light in the far infrared portion of the colour spectrum. “It is the workhorse in dermatology and is commonly used to remove ‘lumps’ and ‘bumps’. The CO2 laser can be used to cut, vapourise or coagulate the lesions (sealing blood vessels).
“The CO2 laser has the unique advantage of sealing blood vessels as it cuts, allowing for ‘bloodless surgery’. Other benefits include minimal scarring, reduced post-operative infection and pain,” he adds.
The other main application of CO2 lasers is in skin resurfacing. This is mainly used in the treatment of scars and wrinkles. Fractional laser skin resurfacing is currently more popular than the traditional skin resurfacing because of less downtime, side-effects and complications.

2. Removal of vascular lesions

The Pulse Dye Laser (PDL) uses organic dyes that are capable of emitting yellow light in a range of wavelengths, depending on the dye chosen. “It is mainly used to treat broken or dilated small blood vessels (vascular lesions) below the skin. Common examples include port-wine stains, spider veins and haemangiomas. A major advantage of the PDL is that infants and children can be treated exceptionally well with minimal risk of scarring,” says Dr. Gangaram.

3. Removal of pigmented lesions

Solid state lasers(Q Switched Nd:YAG, Ruby and Alexandrite Lasers – nano-second) & IPL (intense pulsed light) are used to treat pigmented lesions which contain a high concentration of melanin. Common superficial benign pigmented lesions such as freckles and age spots (lentigenes), brown birthmarks such as the café-au-lait macule, deeper pigmented lesions such as tattoos, and dark-coloured birthmarks such as Naevus of Ota and Hori’s naevus, respond well to these devices.

A newer laser are the pico-second lasers (introduced 2014) which have the advantage of reduced number of sessions required to remove a pigmented lesion and less side-effects.

4. Removal of hair

The types of lasers and light-based devices used in hair removal are the long-pulsed lasers such as the Ruby, Alexandrite, Nd:YAG, Diode 800-810nm and Intense Pulsed Light (IPL) 550-1200nm. According to Dr. Gangaram, cosmetically unwanted hair may be the result of several factors, from heredity to endocrine disorders to exogenous drugs. “Traditional temporary hair removal by shaving, waxing or chemical depilatories has been unsatisfactory. Electrolysis is the only method with some permanency to hair removal, but it is painful, tedious, operator dependent and carries the risk of scarring. Laser-assisted hair removal has been on the scene since 1995/96 and has proven to be effective, and can be used for large areas and has less side effects,” he says.

5. Reduction of fat

“It’s a common complaint: People who are physically fit and at a stable weight still have bulges, rolls, and other small areas of fat they can’t get rid of no matter how much they exercise or diet. Losing abdominal fat and back fat through diet and exercise is practically impossible for many of us,” Dr Gangaram says.

There are both invasive and non-invasive fat targeting treatments in the market today. Lipoplasty is still the most popular surgical procedure. With public demand for non-surgical options, a number of non-invasive fat targeting procedures has now become available. These include cryolipolysis (fat freezing), ultrasound, radiofrequency and low-level laser technology, which have minimal side-effects and discomfort and rapid recovery times and rapid results.

The precisely controlled cooling method is called the non-invasive CoolSculpting procedure. CoolSculpting utilises a precisely controlled cooling method called Cryolipolysis™ (Zeltiq) to target, cool and eliminate fat cells without damaging other tissues. After a one to three-hour CoolSculpting procedure, the patient’s body goes to work. Over the next two to four months, the crystallised fat cells break down and are naturally eliminated from the body.

A low-level laser technology (ZeronaTM), on the other hand, emulsifies the adipose tissue which is then released into the interstitial space. The excess fat is passed through the body during its normal course of detoxification. Ultrasound and radiofrequency devices are also being used with good results.

6. Improvement of Cellulite

Cellulite refers to the cottage cheese-like, mottled, dimpled skin seen commonly on the hips, thighs and buttocks of women. It is caused by the retention of subcutaneous fat between increasingly inelastic, supporting vertical fibrous bands that normally anchor the dermis to the deep fascia, and the projection of this fat into the upper dermis, creating a mattress-like, puckered appearance.

“Light and sound energy are now being harnessed to destroy adipocytes (fat cells) and to direct neocollagenesis (formation of new collagen) through selective dermal heating, in order to improve the skin surface texture with negligible patient down-time.”


Dr. Gangaram Hemandas
Consultant Dermatologist
Prince Court Medical Centre

Dr. Gangaram Hemandas