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Lasers and Lights--A Technological Revolution

Jeffrey Dover, MD, and Amy Kamin January 2007 issue of Skin Inc. magazine

The effects of the world’s technological advances surround us. The result is an ability to do almost anything faster, more efficiently and very precisely. You can tackle and complete complicated tasks with the assistance of modern equipment. Major technological advances are most prevalent in medical science where patients are benefiting from this in the treatment and management of their health care needs. Technology has given patients the opportunity to have procedures performed with little or no anesthesia, less risk of infection, minimal recuperation time and better results. In cosmetic surgery, where a purely aesthetic improvement is the goal, justifying the possible risks that are associated with surgery always has been more difficult for the patient. Technological advances such as lasers, light sources, radio frequency and infrared devices have dramatically reduced procedural risks while increasing the likelihood of excellent results.

Youth: The driving force

Today’s youth-based culture, where attractiveness is defined by looking young and healthy, is certainly the driving force behind the extreme popularity of cosmetic procedures. Combined with dramatic technological breakthroughs, the options afforded interested individuals are numerous, especially in the area of facial rejuvenation. The facelift, the ultimate cosmetic surgical procedure, was first performed by Eugene Holland in Berlin in 1901, and its popularity has increased dramatically throughout the 20th century. According to the American Society for Aesthetic Plastic Surgery (ASAPS), there were 150,401 facelifts performed in the United States in 2005. Compared, however, to less invasive facial rejuvenation procedures, this is a relatively small number.

Just a few years ago facelifting was the only procedure available for the woman who wanted to rejuvenate her facial appearance. Laser and light facial rejuvenation is a relatively new procedure. There were 475,000 such procedures performed in 2005. The availability of cosmetic procedures without incisions that produce a clear complexion and skin that glows, minimizes lines and wrinkles, and tightens skin and reduces the overall look of aged skin has been revolutionary.

The facts

According to Michael Moretti, editor of the Aesthetic Buyers Guide, there were more than 30 million light-based treatments performed in 2005. These procedures generated more than $8.5 billion in gross revenue for physicians and more than $707 million in equipment sales for the technology manufacturers. The skin rejuvenation procedure volume is predicted to increase to more than 90 million treatments in 2010. This will generate $15.2 billion in revenue for physicians and more than $1.1 billion in equipment sales.

Lasers and light sources can treat the skin’s defects and create improvement without changing a person’s original facial shape or outward appearance. This technology precisely targets only the damaged skin, not the healthy skin. The very low risk of side effects makes it highly advantageous over traditional surgical techniques. The speed of a procedure is accelerated; the skin is not cut, bleeding is rare, infections uncommon, and the recovery time very short or nonexistent. This has resulted in an explosion in the numbers of individuals seeking cosmetic services. Due to the ease of these procedures, patients are likely to be more decisive about selecting these treatments, tend to do more procedures on more body parts, and when needed, have more frequent maintenance treatments.

The technology

Lasers produce a powerful beam of a single-color light that can vary in both strength and pulse duration. The basis of virtually all cosmetic skin surgical procedures is spatial confinement of laser energy.

A color of light, or wavelength, is selected that is well-absorbed by the target and the duration of laser exposure, or pulse duration, is selected to allow heating of the target without damage to the surrounding tissue. This affords highly specific tissue damage of only the target leaving all the surrounding tissue unharmed. This is why laser and light skin surgery can be so precise and when done properly, the risks are very low.

Lasers and light sources are highly specialized technological devices. As a result they each have a few specific uses and one such device does not work for all skin problems. As a result several different lasers and light sources are required to be able to treat the various different age-related skin issues. Laser/light treatments are best performed by an experienced and expert physician to get the desired excellent results. See Composition of Lasers.

Intense pulsed light sources

This light appears white but actually is made up of many different colors. It also is called broad-spectrum of light. Like a laser, the intensity and pulse duration can vary. To cause an effect in skin, the light must first be absorbed, just as is the case with laser light, after which the energy is converted to heat. The emitted white light can be adjusted using special filters to eliminate certain wavelengths of light depending on the desired target. See Types of Light.

Common Target Areas explores the latest advances in technology to address the anti-aging market including vascular (broken blood vessels), pigmented (brown sun spots), wrinkles and sagging skin.

Vascular lesions

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

Intense pulsed light devices. These affect pigmented spots similar to the pulse lasers. They are best suited for treating either individual spots or larger areas, and all of the discolored spots within an area such as the face or the hands.

Fractional rejuvenation. Fractional resurfacing and plasma devices remove the upper layer of skin, the epidermis, and it is replaced with a younger-looking, evenly colored skin.


With age, the skin loses elasticity and turgor. Wrinkles and sagging are the result. Without lifelong sun exposure, however, less sagging and far less wrinkling occurs, as the sun is the greatest environmental insult to skin.

Types of wrinkles. Dynamic lines include crows feet around the eyes, frown lines on the forehead and in the glabella (between the brows), as well as smile lines on the cheeks. Static lines include crinkles under the eyes, and lines over the cheeks not directly related to dynamic movement of the skin.

Devices to correct wrinkles. A variety of laser and light-based technologies are available to treat sun-induced skin wrinkles. While they are not particularly effective for dynamic lines, where neuromodulators, such as Botox,* are the treatment of choice, they variably are effective for static lines and also for sun-induced skin discoloration. The different technologies are best divided into ablative, where the epidermis is removed, and nonablative, where the epidermis is left intact after treatment.

Nonablative devices

Fractional resurfacing. Columns of epidermis and dermis are thermally damaged, leaving completely intact skin in between the treated columns. The healthy untreated skin is the source of rapid healing, accounting for redness and swelling for only three days after even an aggressive treatment. A series of six treatments is recommended every three to four weeks, which slowly improves both color and skin texture. The more treatments, the better the results. These devices are effective for mild to moderately deep wrinkles, as well as acne scarring. The treatment is slightly uncomfortable and produces redness and swelling for about three days after each treatment.

Plasma portrait. In plasma skin resurfacing, inert nitrogen gas is delivered to the skin. The plasma energy is absorbed within the skin. Depending on the energy used and the number of passes performed, the layer of altered skin slowly sheds over a period of three to seven days. With this highly versatile device, fine, moderate or severe wrinkles can be treated. The skin peels in a few days following the treatment, under which there is the new tissue formation of healthy new skin. Gentle treatments are very well-tolerated. More aggressive treatments require a topical anesthetic and occasionally oral medication.

Ablative devices

Er: YAG laser resurfacing. This laser wavelength is absorbed by water in skin, which produces removal of fine layers of the skin. The more tissue to be removed, the higher the energy used and the more passes done during the treatment. The treatment is painful, requiring topical anesthesia and occasionally some oral pain medication. The skin peels off over several days. Downtime is proportional to the depth of treatment, lasting from a few days to just more than a week. It is effective in treating mild to moderate sun-damaged skin.

CO2 laser. This pulsed laser, like the Er:YAG laser, is well-absorbed by water and vaporizes skin. Immediately after this gold standard for laser skin rejuvenation treatment, the skin is raw and during a period of seven to 10 days new skin is formed. While the posttreatment course is unpleasant and the procedure painful enough that it requires significant sedation and pain medication done by an expert, the results are dramatic. Fine to deep wrinkles improve as does skin color and overall texture.


Until recently, the only treatment for a sagging face was a facelift, which involves cutting and removing excess skin at the edge of the face. Recent technological advances have brought about several exciting nonsurgical ways to tighten sagging facial skin. Each of these devices work by slowly and safely heating the dermis, producing shrinkage and tightening collagen. Results are modest and are not meant to replace a facelift. For the individual with mild to modest sagging, or for the person with sagging that would benefit from a surgical procedure but who is either not medically fit for such a procedure or who does not wish to have one of these techniques, they offer a very nice alternative.

Nonablative techniques

Several nonablative techniques are available to help treat sagging.

Radio frequency. Radio frequency is a type of energy that, when introduced to the skin, converts to heat that tightens collagen. It can be delivered as a point source (monopolar) or through two rails (bipolar). The number of treatments required and the discomfort of treatment varies depending on the device and energy used. Improvement is seen during treatment and it is maximal six months after treatment.

Infrared light. Infrared light uniformly heats the dermis and shrinks collagen, thus tightening the skin. These treatments are comfortable. Several procedures usually are recommended and similar to FotoFacial RF treatments. Maximal benefit usually is six months after a series of treatments.

The aging process

The visible signs of the aging process are inevitable with maturity. As long as consumers continue to search for youth, manufacturers will continue to develop new technology to address their concerns, and physicians will continue performing cutting-edge procedures. New technology will continue to be introduced into the marketplace. In some cases these will be improved versions or next generations of popular existing devices, but in other cases these will completely replace current treatment modalities. The advantages and challenges of technology are that it changes at a rapid speed and requires both the physician and the patient to be educated and adaptable. All of this is intended to win the battle against the natural aging process, surpassing a patient’s expectations of cosmetic surgery and ultimately creating a youthful, natural appearance.

Related Content



Composition of Lasers

Energy sources

Electrical discharges, chemical reactions and high-powered light sources.

Active medium

Solid, liquid or gas.

Resonant cavity

Main area where the energized medium is amplified.

Common Target Areas



Cutting-edge Technology


Dilated blood vessels

Pulsed dye, Long-pulsed:Nd:YAG, KTP/532nm lasers, and intense pulsed light


Brown spots

Q-switched, KTP/532nm and fractional lasers, and intense pulsed light


Fine and deep facial lines

Short and variable pulsed Er:YAG, Fractional Er:YAG, and CO2 lasers and plasma devices


Loss of firmness and redistribution of fat

Devices that heat the dermis including radio frequency (RF) and infrared (IR) devices

Types of Light

Natural light: A combination of visible and nonvisible colors or wavelengths.

Laser light: A powerful beam of light that is one color and travels in one direction.

Intense pulsed light sources (nonlaser): Appears white, but actually is made up of many different colors of light.

Also called broad-spectrum or broad-band light.

Types of Age-related Vascular Defects

Telangiectasias: Enlarged facial blood vessels.

Cherry angioma: Tiny bright red collections of blood usually the size of the tip of a pencil appearing on the trunk.

Leg veins: Blue veins of various calibers that develop with age. They run in certain families and are much more common after childbirth.

Types of Pigmented Defects

Age spots/lentigines: Flat tan spots due to long-term sun exposure. These may lighten, but do not clear in the absence of sun. They also are called liver or wisdom spots.

Freckles: Flat brown, pigmented spots. These clear totally in the absence of sun.

Melasma: Facial discoloration that is tan in color and is associated with female hormones seen in pregnancy and with taking oral contraceptives.

Seborrheic keratosis: Benign skin growths unrelated to sun exposure that can be flat or raised; colors range from pink to brown.

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