When Arthur Schawlow and Charles Townes published their scientific paper, "Infrared and Optical Masers," in 1958, they were merely interested in creating a new tool to study molecules. Today, lasers have become essential tools for a variety of medical and cosmetic procedures. A vast amount of research has been undertaken specifically to discover newer, safer, and more effective laser uses and treatments for cosmetic procedures. The research has led to new equipment, and, better yet, more satisfied skincare clients.
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LET THERE BE LIGHT
A laser (an acronym for Light Amplification by Stimulated Emission of Radiation) delivers an intense beam of light to a target in the skin. The light is converted to heat and absorbed by the target, which is then destroyed. Because varying wavelengths of light are absorbed by different tissue structures, tissues surrounding the target are left unaffected.
One of the first cosmetic uses for lasers came about in the early 1990s to remove tattoos. When technicians noticed the surrounding hair was disappearing around the treated area, researchers realized lasers could also be used to remove unwanted hair. "A lot of times, new applications are stumbled upon," says Thomas H. Paulino, director of technical and clinical services for Radiancy (Orangeburg, NY), a light-based aesthetic product manufacturer. Laser treatments for acne, for instance, were based on treatments for facial hair removal, notes Paulino. Current laser treatments can tackle myriad skin conditions, including pigmented (brown) and vascular (red) lesions, tattoos, unwanted hair, and wrinkles. Recent research has determined how lasers can treat other conditions, such as melasma, a brown facial discoloration usually found in women who are pregnant or taking contraceptives. Candela Corporation (Wayland, MA), a manufacturer of medical and aesthetic lasers and light-based technologies, recently received clearance from the Food and Drug Administration (FDA) to include sebaceous hyperplasia in the list of conditions that its Smoothbeam diode laser can treat. Besides acne, scar, and wrinkle treatment, the laser is now approved to eradicate these small yellowish papules on the face and chest. Seminal research into how people of color could reap more benefits from lasers has been conducted by Eliot F. Battle, Jr., M.D., one of the founders of Cultura Medical Spa in Washington, D.C., and a member of the Medical Spa Association. "When a Caucasian client walked in, I had a large variety of laser options, or dermatological options, but when a person of color walked in, I was limited in what I could offer," says Battle. During a three-and-a-half-year research fellowship at Harvard, Battle and his colleagues developed dozens of FDA-approved treatments, expanded the uses of existing technology, and invented new equipment, including the Lumenis LightSheer. He collaborated with notables in the field, such as Rox Anderson, M.D., at the Wellman Laboratories of Photomedicine, as well as equipment manufacturers Altus Medical (now Cutera), Candela, Laserscope, and Palomar. Through his research, Battle discovered that aggressive skin cooling combined with slower and safer laser wavelengths and in-depth knowledge of the differences in skin of color—brought about by an analysis with the Visia complexion analysis system—could provide color-blind laser treatments where infrared light is not absorbed by pigment.
 laser term lowdown |
Robert A. Weiss, M.D., associate professor in the Department of Dermatology at Johns Hopkins University School of Medicine and director of Baltimore's Laser Skin & Vein Institute, has been working on several research projects involving new laser uses. "We are doing a study on photo-pneumatic therapy (PPX) and its effects for painless skin rejuvenation," says Weiss, describing a technique that combines laser or light therapy with suction for virtually painless hair removal and skin smoothing, as well as the treatment of brown spots. "We are also involved in testing new forms of photodynamic therapy with pulsed dye and intense pulsed light (IPL)." Other innovations on the horizon include LED photo-modulation (the use of low-energy light sources to stimulate collagen production) and pairing two different lasers for more effective vascular treatments (one wavelength primes the vessel and readies it for the second wavelength, which can then shrink the vessel more easily).
ENLIGHTENED EQUIPMENT
Whether ruby or alexandrite, diode or pulsed dye, different types of lasers are recommended for particular skin conditions. A pulsed dye laser, which creates its light from an organic dye-in solution, for instance, works well for vascular lesions. The yellow light of the laser is readily absorbed by blood vessels and red targets. Cynosure, a medical laser and light source technology company (Westford, MA) makes two pulsed dye lasers: the VStar and PhotoGenica V. The company also has alexandrite lasers, which work well to remove unwanted hair, pigmented lesions, and wrinkles, as well as Nd:YAG lasers for hair removal, leg and facial spider veins, and wrinkles in all skin types. Candela's Nd:YAG laser, the GentleYAG, also treats leg and facial veins, unwanted hair, and wrinkles. However, its newest application is for skin rejuvenation and tightening.
One of the latest comers to the scene is Fraxel technology. The Fraxel SR Laser from Reliant Technologies, a laser device company based in Palo Alto, CA, deeply penetrates the skin with thousands of microscopic columns of light that treat the targeted area without damaging the surrounding tissue. Fraxel therapy is showing great promise in treating melasma and acne scars, two conditions resistant to other treatment methods.
 laser therapy resource guide |
Though lasers have had to compete in recent years with other light-based therapies, such as intense pulsed light, practitioners and researchers say they won't be replaced. They can, however, be combined to make novel treatment systems. One team of researchers advised that the effects of treatments with two different systems, such as the Palomar Estelux Pulsed Light System and the Palomar Q-YAG 5 Laser System, may lead to better overall results. Sciton, another laser manufacturer in Palo Alto, CA, offers this combination approach in the Profile, which has a platform that can be customized to include up to four laser modules with a pulsed-light module, as well as cooling accessories and scanners. A physician, for instance, may want the Microlaserpeel to perform laser peels, and then use the Thermascan module to penetrate beyond the surface to stimulate fibroblasts deeper in the skin, which in turn produce new collagen and give clients' skin a tighter, firmer appearance.
Even companies that have traditionally offered only light-based equipment are realizing that lasers are still in demand. Radiancy, for example, which specializes in LHE (light and heat energy) phototherapy, offers a small desktop Nd:YAG laser called the Whisper. "I see a lot of companies that were just laser companies now introducing smaller light-based machines as well," says Paulino. But light therapies won't be nudging lasers out of the game anytime soon. "Everything has its place in the market," he points out. "The [laser] machines are getting smaller, less expensive, more portable, and reliable. That's really the whole trend of everything these days." —Jenny Sherman