Zap! Laser Myths Debunked

In this series we will share about laser therapies. Laser resurfacing is a technique used for treatment of wrinkles, scarring (acne or surgical), stretch marks, spider veins (telangiectasias) and sun damage (solar melanoma, actinic keratosis (thick, scaly or crusty skin).

What is Laser?

Let’s dive in and try to untangle the mystery that shrouds cosmetic lasers.

Laser is an acronym for “Light Amplification by Stimulated Emission of Radiation” they work by emitting a wavelength of high energy light, which when focused on certain skin conditions (e.g sun spots) will create heat and treat the problem via destruction (e.g. removing the sun spots). There are many different wavelengths (or colours) of lasers because each wavelength treats different things. For the purpose of this exercise we shall split the lasers into 4 categories: ablative laser, non-ablative lasers, fractional lasers and non-lasers.

1. Ablative Lasers:  Focus on the outer layer of the skin by creating micro wounds on the surface.
2. Non-Ablative Lasers: Pass safely through the outer layer of the skin by penetrating the tissue lying beneath. They can treat skin issues without damaging the surface of your skin, non-ablative lasers are considered an improvement as they require less recovery time.
3. Fractional Lasers: Fractional laser beams are split into hundreds of tiny beams (a bunch of dots) instead of a solid beam. When fractional laser penetrates the skin, it penetrates in a scattered way, treating some skin while leaving skin in between alone. The spread-out dosage means that you receive the same benefits minus the downtime. Fractional lasers can be either ablative or non-ablative.
4. Non-Lasers: Pretty much everything else, devices such as Radiofrequency (RF), Intense Pulsed Light (IPL), Infrared, and Ultrasound fall into this category.

Types of Laser

1. Ablative Lasers: Carbon Dioxide Laser (CO2), Erbium Laser
   • Carbon Dioxide Laser (CO2)
     A carbon dioxide laser is very strong and can cut into or vaporize skin tissue. A continuous wave of carbon dioxide laser is not as favourable anymore to treat facial skin conditions because of the long downtime. Instead of CO2 Laser used on skin today are fractional carbon dioxide lasers. CO2 lasers are mostly used for removing moles nowadays.
     • Treats: Moles, Deep Wrinkles, Acne Scars/Scars, Warts, Birthmarks, Saggy Skin, Corns on Feet, Sun Damage
     • Side Effects: Long downtime with high risk of scarring and redness. Asians have higher risk of hyper-pigmentation or hypo-pigmentation.
     • Suitability: Not suitable for those with active acne. Not suitable for stretch marks.
     • Brands: Fraxel re:pair, Smartxide, Mixto Pro and Harmony Pixel Perfect
   • Erbium Lasers
     Like CO2 lasers, Erbium lasers can vaporize the surface of your skin. However, they do not penetrate as deep as CO2 therefore they are best suited to treating wrinkles and photoaging on face, hands and neck.
     • Treats: Fine Lines, Small Wrinkles, Skin Pigmentation, Acne Scars, Sun Damage, Moles
     • Side Effects: Swelling, bruising and redness.
     • Suitability: Darker skin tones can use this laser.
     • Brands: Harmony Pixel Laser
2. Non-Ablative Lasers: Pulsed-Dye Laser (PDL), Nd: Yag Laser, Alexandrite Laser
   • Pulsed-Dye Laser
     As the name suggests, a pulsed laser delivers the laser beams in pulses. Instead of lasing your skin in one continuous beam, the laser pulses and zap your skin in beats. There are varying lengths of zaps for pulsed lasers. The light is converted into heat destroying the blood vessels while leaving the surrounding skin undamaged.
     • Treats: Vascular Lesions, Spider Veins, Port Wine Stains, Rosacea, Broken Capillaries, Fine Lines Around Eyes, Stretch Marks
     • Side Effects: Bruising, temporary pigmentation
     • Suitability: Not suitable for those who have blood disorder, diabetes or certain auto-immune conditions
     • Brands: VBeam, Medlite C6, Revlite
   • Nd:Yag Laser
     Nd:Yag’s very long name is Neodymium-Doped Yttrium Aluminium Garnet. It is one of the most common lasers available with both continuous and pulsed modes. There are a variety of Nd:Yag laser that are used to remove unwanted hair or to treat skin veins (spider veins) and facial redness.
     • Treats: Hair Removal, Spider Veins, Skin Pigmentation, Tattoo Removal, Skin Rejuvenation
     • Side Effects: Low success rate for skin issues. Chance of recurrence when used for vascular lesions.
     • Suitability: Does not remove light/white hair.
     • Brands: GentleYAG, Cool Glide, Laser Genesis, Cool Touch
   • Alexandrite Laser
     The laser source is Alexandrite, it is mainly used for hair and tattoo removal. The Alexandrite laser is specifically good at removing green and black coloured pigments in the skin.
     • Treats: Hair Removal, Tattoo Removal, Leg Veins
     • Side Effects: Redness, swelling and itchiness after procedure may last a few days. Skin Pigmentation (rare). Bruising may affect some.
     • Suitability: Better at removing finer/ thinner hair. Good for removing black/green/ yellow coloured tattoos. Good for pale skin tones.
     • Brands: GentleLASE, EpiTouch Plus
3. Fractional Lasers: Fraxel
   • Fraxel
     Moving onto Fractional lasers, Fraxel is from a family of three cosmetic lasers made by a company called Solta. All three lasers in the Fraxel family use fractional photothermolysis to treat certain skin conditions.There are two non-ablative Fraxel lasers and one ablative laser. The two non-ablative lasers are Fraxel re:fine (used for skin rejuvenation and minimizing fine facial lines, and Fraxel re:store (used for skin resurfacing, treating photodamaged and reducing the appearance of acne scars). The ablative laser is Fraxel re:pair, which uses CO2 laser to treat skin pigmentation and deeper facial wrinkles.
     • Treats: Hyperpigmentation, Sun Damage, Wrinkles and Acne Scarring
     • Side Effects: Redness.
     • Suitability: Not suitable for those who have skin cancer, has broken skin around targeted area or is pregnant/breast feeding.
     • Brands: Fraxel, 3Juce, Pixel
4. Non-Lasers: Intense Pulsed Light (IPL), Infrared, Radiofrequency, Ultrasound Imaging
   • Intense Pulse Light
     IPL is a form of treatment that uses flashlamps (not lasers) to produce a high intensity light from specific flash lamps to selectively destroy pigment cells, capillaries and hair roots on your skin.IPL is a non-invasive, non-ablative method for rejuvenating photoaged skin with minimal side effects. It is often used to treat dyschromia, rosacea, melasma, acne, photodamage, vascular and pigmented lesions, hair removal and rhytides.IPL is best suited for people who have pale skin. Though post-treatment side effects resemblance of sunburn, some people actually experience skin blisters.
     • Treats: Rosacea/ Facial Redness, Broken Blood Vessels, Pigmentation, Skin Tightening (rarely used to treat hair removal, tattoo removal)
     • Side Effects: Redness, swelling, bruising, scabbing and sometimes pigmentation.
     • Suitability: Not suitable for those with darker skin tones
     • Brands: Lumenis, EpiLight, Quantum, PhotoDerm, Aculight
       
   • Infrared
     Another form of cosmetic lasers, it is most often used for non-surgical fact lift. The heat from the infrared energy contracts but does not destroy collagen in your skin. It tricks your skin to increase productivity for collagen to replace “lost collagen” resulting in a lifting effect on your skin.
     • Treats: Skin Tightening, Facial Contouring, Non-surgical face lift, Stimulates Collagen, Saggy Skin
     • Side Effects: Redness, swelling, temporary skin pigmentation
     • Suitability: Not suitable if you have heart issues, metal implants. If you are diabetic, have autoimmune disease or been treated with chemotherapy this treatment is not suitable.
     • Brands: Titan
   • Radiofrequency
     The most common source of radiofrequency is Thermage. Radiofrequency is used to heat (or damage) deep layers of your skin (without damaging the surface) so your body will heal the injury, thus producing more collagen to tighten skin making you look younger.
     • Treats: Skin Tightening, Facial Rejuvenation
     • Side Effects: Contracts Fat cells makes face look thinner due to fat loss
     • Suitability: Not suitable for those who are pregnant/breastfeeding
     • Brands: Exilis, Thermage
   • Ultrasound Imaging
     Ultrasound is considered the newest energy source for cosmetic medical procedures. With ultrasound imaging it allows you to visualize the tissues beneath the surface of the skin. This means that you can see where the damage is located and can target them more accurately. Ultrasound facial procedures rejuvenate the skin and minimizes sagging.
     • Treats: Skin Tightening, Increases Collagen Production, Improves Skin Elasticity, Firming Skin
     • Side Effects: Slight swelling, tingling, bruising, sensitive to touch, temporary numbness
     • Suitability: Great for those who do not want a surgical facelift.
     • Brands: Ulthera
   • Cryolipolysis
     Is an FDA-approved procedure also known as Coolsculpting. The method involves controlled application of cooling within temperature range of -11 to +5 C for the non-invasive, localized reduction of fat deposits, intending to reshape the contours of the body. The degree of exposure to cooling causes cell death of subcutaneous fat tissue, without damaging the overlying skin. It is often used for areas that are hard to lose fat like love handles.
     • Treats: Visible bulges in the thigh, abdomen, flank, areas along the bra line, back fat, underneath the buttocks and upper arm
     • Side Effects: Localised redness, bruising and numbness of skin
     • Suitability: Great for those who do not want Liposuction or Surgery
     • Brands: Coolsculpting

Things to Note:

Aside from lasers, there are other ways for skin rejuvenation to be achieved, these include:

1. Chemical Rejuvenation uses chemical peels (e.g. Fire & Ice)
2. Mechanical Rejuvenation: uses dermabrasion or micro-needling (e.g SilkPeel)
3. Injections for Rejuvenation: uses injectable neurotoxin, fillers and collagen

One of the benefits of using laser is that it allows the aesthetic physician to customize the treatment for each patient to specific areas of their face. Laser can also be combined with Liposuction to help tighten and smooth over the new contours after removal of excess fat.

Myths and Misconceptions about Laser Therapies

Myth: Lasers can make your skin perfect

Truth: Laser can make your skin look younger and better but not entirely flawless. People who undergo treatment will notice a drastic difference but the imperfections will not disappear completely. That’s especially true if you choose a non-ablative or fractional laser treatment. You will often find that non-ablative lasers produce less dramatic results.

Myth: Anyone can get laser resurfacing done

Truth: Laser resurfacing works best on fair-skinned people who don’t have active acne flares or frequent cold sores. People who have darker skin tones will need to be careful and consider other options such as RF or micro-needling. The laser itself could cause acne breakouts on treated skin, so those who have active acne will need to consult with their doctors beforehand about their options.

Myth: Laser treatments can replace surgery

Truth: A laser treatment can be used to complement a facial plastic surgery but since surgery and lasers target different concerns, they can’t be exchanged for one another. The more mature the skin is, the less collagen and elastin it contains, hence the formation of deep lines and wrinkles, lasers are great for improving the texture and tone of the skin. Lasers however cannot remove skin laxity or dramatically tighten skin. For skin that’s suffering from extreme laxity, surgery is the best option.

Myth: Lasers make skin weak or thin

Truth: Laser peels actually make the skin stronger. Although ablative lasers are used to peel the skin and remove the top layer, this action encourages the skin cells to grow and replace the older damaged cells. The treated skin may look rough initially but ultimately will strengthen and thicken by the production of collagen and elastin. Collagen supports the skin structurally and will cause it to become thicker, stronger and more youthful looking.

Myth: Lasers use dangerous radiation

Truth: Laser used for skin treatments emit radiation in the form of light, and they do not expose you to dangerous radiation. The light will only penetrate one to four millimetres into the skin. Laser radiation should not be confused with harmful radiation which comes in the form of radio waves, ionizing, x-rays, or radiation from radioactive elements such as radium. At Beverly our goal is to improve your skin.

Myth: Laser can cause cancer

Truth: The light emitted from laser does not contain the wavelengths which causes or triggers cancer. Therefore, lasers do not cause cancer and actually be used to remove skin cancers.

Myth: Lasers are only for mature skin types

Truth: I’m sure you’ve heard the saying; prevention is better than cure. Likewise, in aesthetic treatments it does not apply only to older generation. Many of us tend to ignore our skin problems in our youth thinking that topical skincare is sufficient to fend the signs of ageing or sun damage. This will intensify the skin problems making it a lot harder for treatments to reverse the damage. Undergoing early treatments can reduce pigmentation and improve the skins collagen production dramatically. You can start doing laser treatments as young as 25, stimulate your collagen while you still have them. If you are mature, you might need more sessions to get the same results for collagen production/stimulation.