Fourth Quarter 2008, Volume 22, Number 2

Laser surgery, treatment and options


The increase in popularity of cosmetic surgery over the last decade

Laser surgery, treatment and options

Ask the Surgeon / Health Tip / What’s New

Hospital, surgical center, office, does it matter?

Laser is an acronym for light amplifica-tion by the stimulated emission of radiation. It is a high-energy beam of light that can selectively transfer its energy into tissue. The wavelength peaks of the laser light, pulse durations, and how the target skin tissue absorbs this, determine the clinical applications of the laser types.

Over 40 years ago, the first lasers were used to treat skin conditions. The argon and carbon dioxide laser lightened birthmarks, but had a high rate of scar formation. Major advances in lasers over the past 20 years has revolutionized the use and treatment of many skin conditions. Today, there is a wide spectrum of laser and light technologies available for skin rejuvenation and resurfacing.

The skin is composed of the epidermis and the dermis. Superficial wrinkles and pigmenta-tion problems generally originate in the epidermis. Within the dermis are two layers-the papillary dermis and the reticular dermis-both of which are constructed of collagen, long fibers that loosen and stretch with age and sun damage. If the deepest layer, the reticular layer, is damaged, scars result; while the upper layer of the dermis, the papillary layer, heals from injuries without scarring.

The extent of laser resurfacing depends on the type of laser used. It can diminish wrinkles, skin irregularities, and scars. It can improve the overall skin tone and texture of your skin. After resurfacing during the repair process, your skin rebuilds the tissue allowing a fresh new layer to become the skin surface. Your physician will discuss with you the optimal strategy for improving your appearance, including the type of laser and treatment to best meet your needs.

Ablative lasers remove the upper layers of the skin using the power and heat of the light in a targeted beam. Common lasers include carbon dioxide (CO2) or erbium. The skin is wounded; anesthesia is usually required and there is considerable downtime while the skin crusts, sheds the scabs, and fully heals. The major advantage to this invasive laser resurfac-ing is that the results are dramatic and long-lasting. Post-operatively, patients must stay out of the sun to avoid damaging the new skin.

Non-ablative lasers include diode, intense pulsed light (IPL), or pulsed dye. These lasers generate heat in the dermis layer to stimulate collagen production and improve the tone and texture of the skin. The upper layers of the skin remain intact, which results in minimal to no downtime and very little discomfort. This treatment may be used to treat acne, veins and discolorations, permanent hair removal, and wrinkles.

Layers of the skin:
A. Epidermis
B. Papillary dermis
C. Reticular dermis

Skin resurfacing removes the epidermis and penetrates into the papillary dermis, which responds by producing new collagen.

A new laser treatment is called fractional resurfacing. The laser treats a fraction of the skin by causing microscopic “wounds” within the targeted areas in the dermis layer. These targeted areas are treated intensively, while leaving the surrounding tissue unaffected. This allows the “wounds” to heal must faster versus if the entire area were affected. Through the healing process, new healthy skin emerges. The United States Food and Drug Administration (FDA) has approved this new fractionated laser therapy to treat acne scars, age spots/brown spots, melasma, and wrinkles around the eyes.

If you are considering laser surgery, keep in mind that many procedures can be performed with different lasers. The choice of laser will depend on the skin condition, size of the treatment area, skin type, ethnic background, and patient expectations. !