Definition:

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 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.

Types of Lasers

Lasers can be grouped into:
• Gas lasers e.g. CO2, Erbium: YAG (Er:YAG) lasers
• Dye lasers e.g. Pulse dye laser
• Solid state lasers e.g. Nd:YAG(Neodynium-Yttrium Garnet), Alexandrite, Ruby lasers
• Diode lasers

Signs and Symptoms :

Usually the patient is not aware of the disease that he/she is suffering. In some of these patient, it is a silent disease causing unnoticed swelling in the body affected. Other sign of bone cancer is pain especially at night. The pain is progressive and not control by normal ‘pain killer’. Bone cancer may lead to fractures as it infiltrates and weaken the bones and finally they were loss function of the limb. In advanced cases, the cancer can grow very large and the patient begin to show lost weight and become cachectic. In such situation amputation is a treatment of choice.

Uses of Lasers :

C02 Laser

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.

Pulse Dye Laser (PDL)

The pulse dye laser 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.

Q Switched Nd:YAG, Ruby and Alexandrite Lasers

“These solid state lasers 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 lasers.

Laser Hair Removal

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 Nd:YAG laser, and Intense Pulsed Light (IPL) 5501200nm. 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 few side effects,” he says.

Fat Reduction

“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 two non-invasive ways of fat reduction. One, is the use of a precisely controlled cooling method and the other with a laser. The 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.

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 skin surface texture for a permanent, localised treatment with negligible patient down-time.”

There are various uses of lasers, including:

• Removal of vascular lesions, eg. port-wine stains, haemangiomas, telangiectasias
• Removal of pigmented lesions, eg. freckles/lentigenes, café-au-lait macules, Naevus of Ota, Hori’s naevus, tattoos
• Removal of ‘lumps’ and ‘bumps’ (benign or malignant skin tumours)
• Removal of scars and wrinkles (laser skin resurfacing)
• Hair removal
• Reduction of fat
• Improvement of cellulite

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

Dr.-Gangaram-Hemandas
Dr. Gangaram Hemandas
Consultant Dermatologist
Prince Court Medical Centre

Dr. Gangaram Hemandas