LASER SKIN TREATMENTS
What kinds of laser are available?
The colour of the beam depends on the chemical dye through which the particles of light pass and the wavelength of the light. The red, longer wavelengths penetrate the skin more deeply than the short violet ones. Ruby lasers are used to treat brown marks, such as liver spots, dark circles under the eyes and freckles, and also tattoos. The yellow-pulsed dye laser is used to treat red marks, such as port-wine stains, spider veins and also warts. The most versatile laser of all is the new carbon dioxide laser with a skin resurfacing attachment such as Ultrapulse or SilkTouch, which is used to treat fine lines and wrinkles.
How do lasers work?
The carbon dioxide laser vaporizes the treated surface before much heat can be conducted to the lower layer of skin which is therefore not damaged. The surgeon maps out squares of skin each of which are treated in a few micro-seconds. Each pulse removes a very fine layer of epidermis, just a few cells thick. The heat that does reach the underlying skin actually appears to shrink collagen (the skin's scaffolding) and promote the production of connective tissue, so skin becomes tighter and smoother.
What does skin resurfacing involve?
For small areas you will have anaesthetic cream applied to your face before being given a sedative. Local anaesthetic will be injected into sensitive areas around the lips and eyelids, and you will wear a special shield over your eyes. Treatment of the whole face takes around an hour and a half and is often done under general anaesthetic. Pain will take up to 24 hours to disappear, but you will be able to go home four hours after treatment. In the third week after treatment you may look wonderful - because the residual swelling will make your new skin look as if it is completely wrinkle-free. In the fourth week, however, wrinkles will start to show up again. Over the next few months though, your skin should continue to show improvements and the discoloration in the skin lessens.
Pigment Change
What does portwine stain and birthmark removal involve?
Lasers are now the treatment of choice for these blemishes - a ruby laser for dark birthmarks and a yellow-pulsed dye laser for red ones. Patients describe the sensation of the ruby laser as similar to the ping of having a rubber band snapped against skin. The yellow-pulsed dye laser has more of a dull thudding sensation. Patients often require more than one treatment, spaced by several weeks.
What causes liver spots, and how can they be treated?
These round flat brown areas of skin which should be called sun spots, are caused by excess development of the skin-darkening pigment melanin on areas of the skin that are constantly exposed to the sun. Treatment with a ruby laser is the method of choice today.
How successful is laser treatment in removing tattoos?
How successful a tattoo can be erased depends on when and how you had the tattoo done and on its colour. Younger tattoos tend to be removed more quickly and easily than much older ones. And removing amateur Indian ink tattoos may be less predictable due to the differing depths of pigment. Five to ten sessions of laser treatment are generally required.
Isn't there any danger of damaging surrounding tissue in the laser removal of tattoos and blemishes?
No. A combination of selecting the right wavelength and pulse allows lasers to deliver energy faster than the surrounding tissues can conduct the heat, so they are not damaged. The Q-switched ruby laser, for instance, delivers light in nanoseconds (a nanosecond is a thousand millionth of a second), so that the melanin in liver spots is destroyed without any harm being done to the other layers of skin.
What are the after effects?
Redness and inflammation, similar to sunburn with burning and peeling of the skin for around three weeks.
What about the risks?
The carbon dioxide laser is extremely accurate to use. The surgeon can see very precisely how deep he or she is going. The risk of going too deep is small. The main disadvantage of laser resurfacing is that it produces redness which can last three to four months. But later colour changes in the skin may occur with the skin either ending up slightly darker or slightly lighter.
