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Lasers and Lights--A Technological Revolution

By: Jeffrey Dover, MD, and Amy Kamin
Posted: June 6, 2008, from the January 2007 issue of Skin Inc. magazine.

page 3 of 6

With aging and sun damage, blood vessels slowly dilate and appear as red linear vessels on the face, especially the cheeks, chin and sides of the nose. The enlarged facial blood vessels are known commonly as telangiectasias. The direct light from the laser beams and intense pulsed light devices are absorbed by red cells within the vessel, and the energy converts to heat causing the blood to clot and the vessel to collapse while not disturbing the surrounding healthy skin. See Types of Age-related Vascular Defects.

There are various types of lasers that have the ability to destroy vascular lesions by targeting the red pigment. The pulsed dye and Potassium Titanyl Phosphate KTiOPO4 (KTP) lasers and intense pulsed light (IPL) devices all are successful in eradicating unwanted vessels. A series of two to four treatments effectively removes small red facial blood vessels, facial redness and facial flushing by selectively targeting the effected vessels without affecting the normal surrounding tissue or the overlying pigment. Treating tan skin must be avoided as this interferes with the light penetration to the desired target, thus decreasing the effectiveness of treatment. It also can cause temporary unwanted hyperpigmentation and hypopigmentation.

Pigmented lesions

Long-term sun damage frequently presents itself as brown blotchy discolored spots called lentigines. Discoloration makes the skin look older; even-colored skin connotes a young, fresh appearance. Today’s light-based technology targets the unwanted skin pigment that contains melanin and destroys those cells, while leaving the normal surrounding and underlying skin relatively untouched. To be successful, the wavelength of light must be selectively absorbed by melanin. While flat pigmented spots respond well to light treatment, raised areas frequently seen in aging skin unrelated to sun damage—called seborrheic keratoses—typically are not treated with light. See Types of Pigmented Defects.

Treating pigmented lesions

There are many types of laser and light sources used to treat pigmented lesions.

Pulsed lasers. Pulsed lasers are ideal for individual brown spots. Q-switched lasers such as the Alexandrite, Ruby or Nd:YAG can target the lesion size for precision damage. The unwanted brown spots are removed, leaving the surrounding skin intact. Several treatments are required for optimal results. As with all light devices used to treat pigment, best results are achieved in light-skinned individuals where there is less competition between the brown spot and the natural skin color. The risk of too much lightening or reactive increased pigmentation is much higher in darker-skinned individuals