Cosmetic Laser Procedures Explained

Cosmetic Laser Treatments

Cosmetic Laser Surgery is becoming a replacement for traditional cosmetic surgery. Cosmetic laser treatment centers are more common place and offer effective cost effective treatments for the consumer. Cosmetic Laser centers offer many different types of cosmetic lasers that that are in specific cosmetic treatments. Cosmetic laser treatments include; smartlipo, laser blepharoplasty, laser resurfacing, laser scar removal, laser breast reduction, laser breast reduction, laser hair removal, laser eye surgery, laser acne removal, laser tattoo removal, and laser stretch mark removal.

Most Popular Aesthetic Laser Procedures

Cosmetic laser surgery, performed in a cosmetic laser center with safe, FDA-cleared cosmetic laser equipment, has become an effective and popular replacement for many traditionally invasive cosmetic surgery procedures. There are many non-invasive, cosmetic laser procedures that continue to replace traditional surgery. In 2009, according the American Society of Aesthetic Plastic Surgeons, laser hair removal, skin rejuvenation, and laser skin resurfacing already surpass the most popular surgical cosmetic treatment (breast augmentation), and at current growth rates, skin tightening, treatment of cellulite and body shaping are not far behind.

Popular Cosmetic Laser Procedures

  • Acne Reduction
  • Body Shaping
  • Fractional Skin Resurfacing
  • Laser-Assisted Lipolysis
  • Laser Hair Removal
  • Pigmented Lesion Removal
  • Skin Rejuvenation
  • Skin Tightening
  • Tattoo Removal
  • Vascular Lesions

Laser Hair Removal

Since its introduction in 1995, light-based hair removal has become one of the most popular cosmetic surgical treatments. Dozens of devices have been FDA cleared with most approved for permanent hair reduction. Continual technological development has resulted in better results on a wider population of patients, at a lower treatment price than ever before. While earlier light-based procedures such as skin resurfacing or vein removal were specialized treatments that required medical knowledge and training, light-based hair removal has become a simple procedure that nurses, electrologists or aestheticians can perform.

Light-based hair removal offers the broadest overall advantages with the fewest disadvantages. After a series of three to five treatments, spaced at approximately ten-week intervals, individuals may remain hair-free for a year or more. Discomfort tends to be minimal compared with other hair removal procedures, as are treatment side effects. Nonetheless, usage of light-based hair removal continues to rise and is cannibalizing utilization of older hair removal technologies. In 2009, electrologists billed almost $300 million for treatments worldwide. This is projected to fall to $210 million by 2014 as light based hair removal treatment volume increases.

Skin Rejuvenation

Over the past few years, skin rejuvenation has become the most popular light-based aesthetic procedure of all physician performed treatments. The term refers to an ablative or non-ablative means of enhancing the appearance of the skin by stimulating the regeneration of collagen. It includes both conventional and new fractional devices specifically developed for collagen regeneration, pulsed dye lasers that were originally FDA cleared for treatment of vascular lesions and multi-functional intense pulsed light (IPL) devices that perform a variety of functions including removal of pigmented lesions. While specific performance amongst the different devices can vary, there are some commonalities.

First, skin rejuvenation tends to be used to diminish the signs of aging and/or photodamage such as sun-induced freckling. It may be used on the entire face or selected areas (such as wrinkles, freckles, etc.).

Second, unlike the procedure’s predecessor, laser skin resurfacing, skin rejuvenation is a non-invasive or minimally invasive technique that requires little, if any, healing time. Patients may schedule lunchtime procedures, and return to their normal activities by afternoon. This is very appealing for those not able to take a week or more off work to recover or individuals who wish to conceal the fact that they have had a cosmetic procedure. Many physicians have shifted substantial portions of their practices from resurfacing to rejuvenation procedures for this reason.

Last, the mechanism of action appears to be stimulation of collagen. As research into aging has progressed, collagen – or lack of it – appears to be closely linked to sagging, sallow skin, wrinkles and other signs of aging. High levels of collagen, however, are associated with the plump, firm, smooth skin of youth. While different therapies attempt to replenish the collagen by different means, light-based devices operate on the principle that heating the blood vessels will result in the skin producing more of the body’s own collagen. This theory arose from observations that people with superficial facial burns often looked significantly more youthful after the burns had healed. These devices target the red hemoglobin and deoxyhemoglobin in the blood vessels just underneath the epidermis. The irradiated vessels then secrete inflammatory factors such as histamine and procollagen which in turn stimulate fibroblast formation or new cells within the dermis.

While men may account for as many as 20% of all skin rejuvenation patients, women aged 30 to 65 represent the largest patient base. This is an ideal patient demographic, dovetailing perfectly with the large number of aging baby boomers in the U.S., Europe and Japan. It is also a gradually widening range, as more and more young women seek treatments that will delay the signs of aging and older women increasingly seek procedures that will maintain results they have achieved with prior treatments. Facial areas are the most commonly treated, since the face represents the most visible part of the body and the area that often shows age first. In a recent independent survey of 2,000 patients willing to consider cosmetic procedures, for example, 57% of women were interested in cosmetic procedures that reduce lines, wrinkles, crow’s feet and bags around the eyes. However, treatment of the hands, neck, chest or forearms is not unusual. Light-based devices can help fade age spots and make the skin appear clearer, younger and brighter.

Unlike skin resurfacing, skin rejuvenation generally does not produce immediate results. Rather, results appear gradually as collagen production increases over weeks or months following treatment.

Tattoo and Pigmented Lesion Removal

Tattooing is an art dating back at least five millennia. Since then, tattoos have served as markers of status and rank, symbols of religious and spiritual devotion, decorations for bravery, pledges of love, talismans, symbols of protection and as the mark of outcast, slave or convict. Today, people often choose to be tattooed to indicate their identification with certain groups as well as for religious reasons. Others view tattooing as a means of self-expression, and obtain tattoos to decorate their bodies or commemorate significant events in their lives. While tattoos had previously been limited to discrete designs, full-body art is now becoming common, wherein a person’s full arms, legs, back, chest, etc. are covered with elaborate images, many of which may be created exclusively for that client. Several reality television shows (Miami Ink, LA Ink) as well as a growing number of specialized lifestyle publications (Tattoo Collector Magazine, NW Tattoo Magazine, Prick Magazine, Inked, etc.), have further popularized the practice.

In North America, more than 50 million people are believed to have at least one tattoo. According to a Harris poll of tattoo trends in the U.S.: 16% of all adults in the U.S. have at least one tattoo;

The highest incidence of tattoos is among the gay, lesbian and bi-sexual population (31%), Americans ages 25 to 29 years (36%) and Americans 30 to 39 years (28%);
Those living in the West are more likely to have tattoos (20%);
Democrats are more likely to have tattoos (18%) than Republicans (14%) and Independents (12%);
Equal proportions of males (16%) and females (15%) have tattoos.

However, as lifestyles change, it’s not uncommon for individuals to wish to remove a tattoo. One physician who specializes in tattoo removal estimates that half of those who get tattoos later regret them. This has created a large and growing population of tattoo removal clients who are now seeking treatment for removal.

Pigmented lesions result from the presence of melanin in the skin. Cells beneath the skin produce melanin both naturally and in response to factors such as prolonged exposure to sun. A pigmented lesion is caused when the cells produce too much melanin in a localized region. Some lesions are present at birth, but most develop with exposure to the sun or with age. When the pigment is located in the epidermis, light brown spots occur, such as freckles, cafe-au-lait birthmarks and sun spots. When the pigment is found deeper in the skin, dark brown spots can result, such as Nevus of Ota or other moles.

Light-based systems that perform these procedures have been sold since the early 1990s. They are considered established, predictable treatments and have become the method of choice for removing tattoos and pigmented lesions. However, while older systems performed just tattoo and lesion removal, newer systems include this functionality with other capabilities such as hair and/or vascular lesion removal. Newer devices are also able to address darker, multi-colored and complex tattoos more efficiently, providing more thorough removal in a fewer number of sessions.

Acne Reduction

Acne is a skin condition that manifests as various types of bumps including whiteheads, blackheads, pimples and cysts. It affects 80% of the world’s population at some point in their lives. At any given time, 17 million people in the U.S. alone suffer from acne and actively seek relief.

Acne’s primary victims are teenagers, whose elevated hormone levels trigger excess oil production in the skin. When the pores of the skin become clogged with too much oil, P. acnes bacteria multiply and cause the inflammation known as acne. Most teens get the type of acne called acne vulgaris, which appears on the face, neck, shoulders, back and chest. However, an increasing number of adults between the ages of 20 and 50 also suffer from acne that results from factors including heredity, stress, hormonal changes, medications, birth control pills, heat, sun, friction against the skin, cosmetics, moisturizers and some industrial chemicals.

Light-based devices for treatment of acne offer excellent results without the often severe side effects caused by some medications such as isotretinoin. To date, a wide variety of devices have been cleared by FDA including several different types of lasers and light-based systems.

Additionally, DUSA Pharmaceuticals (Wilmington, Massachusetts, U.S.) obtained FDA clearance to market its Levulan 5-ALA photodynamic therapy treatment for the reduction of acne. However, results released in October 2008 raise questions about how significant a benefit Levulan may provide. In a Phase IIB clinical trial to compare PDT using DUSA's BLU-U light plus Levulan to that of PDT using the BLU-U without Levulan, both treatments were found to be safe and effective without a significant difference in results. Based on these findings, DUSA announced that it will not pursue further clinical development of Levulan PDT in combination with BLU-U for moderate-to-severe acne.

Vascular Lesions

Vascular lesions include a range of conditions including bulging varicose veins on the legs, thin spider veins on the face and discolored patches called rosacea. They are a common condition, affecting up to 50% of women age 18 years and older. In addition to aging, common causes include heredity, hormones, prolonged standing and obesity. Pregnancy can also cause vascular lesions, due to the increased blood volume and hormone levels as well as pressure of the uterus on the deep leg veins as they drain into the pelvis. A small proportion of sufferers are seriously disabled by bulging varicose veins and unable to walk. These cases are best treated surgically with a phlebectomy, which is performed as an outpatient surgery under local anesthesia. Less severe cases, however, may be treated with either light-based therapy or sclerotherapy.

Despite the convenience and excellent results offered by light-based treatment of vascular lesions, the procedure has not yet replaced needle-based sclerotherapy. According to the American Society of Aesthetic Plastic Surgery (ASAPS), almost four times as many sclerotherapy procedures were performed in 2009 as light-based treatment of leg veins. This is due largely to current equipment limitations regarding treatment of very large leg veins and individuals with dark skin tones. Although treatment of vascular lesions has been available since the mid 1990s and sales growth has slowed, the application nonetheless continues to be important because of the market size it addresses and the ability it offers practitioners to provide a full line of aesthetic services. Sales of multifunctional devices that address vascular lesions continue to outpace those of other light-based devices and a large number of manufacturers offer these products.

Fractional Skin Resurfacing

Fractional skin resurfacing is quickly replacing conventional erbium and carbon dioxide skin resurfacing as a means to address deep wrinkles and significant skin damage. While ablative skin resurfacing, which was introduced in the 1980s, requires long healing times, fractional skin resurfacing can achieve similar results with very short downtimes.

Like prior skin rejuvenation techniques, fractional technology is designed to stimulate the production of new collagen in the skin. This occurs over a period of time, as fibroblasts form within the dermis. Coagulated cellular debris is expelled as the skin is remodeled.

However, while non-fractional systems deliver energy uniformly into both healthy and unhealthy tissue, fractional devices are designed to direct photonic energy exclusively to the smaller damaged surface areas while leaving healthy, surrounding tissue intact. These untreated zones, which often include stem cells and melanocytes in the papillary dermis, act as thermal dissipation volumes, allowing for higher energy densities in the treatment spots versus a large spot single exposure. After treatment, the untreated zones then function as healing centers distributed throughout the treatment area. This is particularly important for ablative procedures as it significantly speeds healing compared with a non-fractional approach because these microcolumns can close within one to three days therefore minimizing complications by putting the stratum corneum intact much faster; it also offers a new way to incrementally titrate skin resurfacing treatment from very light to very heavy and enables safe treatment of more delicate areas than was previously possible, such as the neck, chest, arms and hands. Fractional skin treatments allow for the replacement and repair of tissues much deeper than previously possible with traditional laser skin resurfacing.

Depending upon the wavelength of the laser, fractional skin resurfacing may be either ablative or non-ablative, with ablative procedures generally producing a greater degree of improvement. As with non-fractional systems, ablative treatments generally provide a deeper, more significant result in a fewer number of procedures; however, they are often not appropriate for patients with darker skin tones and usually require longer post-procedure healing times (albeit much shorter than healing times for non-fractional ablative procedures). For example, while patients may experience only some slight redness after a non-ablative fractional procedure, CO2 ablative fractional skin resurfacing typically leaves a series of small white spots where the microbeams have penetrated the tissue. After these spots disappear in 10 to 12 hours, the skin becomes red and swollen for several days before drying and flaking off.

Body Shaping and Skin Tightening

Body shaping includes a range of procedures that encompass both subtle and profound improvements such as toning, tightening, smoothing and cellulite reduction on areas both large and small. Treatments are performed using energy-based devices that comprise the following technologies:

  • endermology / vacuum / massage
  • radiofrequency
  • photonic and/or laser
  • laser liposuction
  • ultrasound
  • acoustic wave
  • cryotherapy

Skin tightening is a related, specialized procedure intended to correct skin laxity and reduce sagging. Skin laxity is a common effect of aging and typically begins between the ages of 30 and 40. It occurs when skin loses elasticity and begins to droop or sag. This effect can occur virtually anywhere on the body, but is particularly noticeable around the eyes, mouth, jawline and neck. This loss of firmness is distinct from wrinkling, as many individuals with only minimal wrinkling experience skin laxity. Although many devices claim to offer some degree of skin tightening, few provide visible results and even devices that have been optimized for skin tightening is not fully effective on all patients.

Laser-Assisted Lipolysis

Since the introduction of liposuction in the early 1970s, professionally-performed body shaping has become a popular means to re-contour the body into a more idealized form. Although liposuction is not effective for cellulite reduction, it remains the gold standard for fat removal, particularly for individuals seeking to remove an extra 10 to 30 unwanted pounds.

areas and then suctioning th e fat away. Today, liposuction is often performed using the tumescent technique, an approach developed in 1985 that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. It is therefore less uncomfortable than liposuction under general anesthesia or IV sedation.

The older dry technique does not use injections of local anesthesia into the fat before liposuction. It has largely been abandoned due to excessive blood loss. The wet technique is also an earlier approach. It requires the injection of approximately 100 milliliters of local anesthesia containing epinephrine. Although it caused less blood loss than the dry technique, blood nonetheless composed 15% to 20% of the tissue removed and therefore the wet technique has also largely been discontinued. The super wet technique, which is performed under general anesthesia, requires the injection of a volume of diluted local anesthesia that is less than half the volume used for the tumescent technique. At about 8% of the fluid removed, blood loss with the super wet technique is greater than the tumescent technique but significantly less than the wet technique.

Laser-assisted lipolysis requires the use of tumescent fluid and a microcannula inserted through a small incision to deliver laser energy and heat into subcutanteous fat. It can target specific body parts that were difficult to access with the more traditional methods, but are perfectly suited to precise body sculpting.


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