Laser therapy

Laser therapy is becoming increasingly used in Australia for a wide range of skin and cosmetic conditions. The word laser stands for Light Amplification by Stimulated Emission of Radiation.

Laser therapy works by putting out a very high intensity beam of light with a particular wavelength. The light passes through the outer layers of your skin and is absorbed by a specific target, which varies depending on the condition being treated.

Types of laser treatment for your skin

There are many different types of laser that can be used to treat different skin conditions. The different types vary according to several properties, including their source, wavelength and whether they emit light continuously or intermittently.

Some of the different laser sources include argon, carbon dioxide, dye, erbium, neodymium:yttrium-aluminum garnet (Nd:YAG), alexandrite and ruby. These make different wavelengths of light that can be within the visible or infrared spectrums.

Older lasers emit light continuously - this is known as continuous wave (CW). Newer types of laser emit light in bursts. These include quasi-CW and pulsed laser. Pulsed dye laser (PDL) is long-pulsed, whereas quality-switched (QS) and picosecond lasers are very short pulsed.

Ablative vs non-ablative laser therapy

Ablative laser therapy removes the outer, thin layers of skin and heats the deeper layers, causing collagen to shrink. When the skin heals it is replaced with smoother, tighter skin. Erbium and carbon dioxide lasers are examples of ablative lasers.

Non-ablative laser therapy simply stimulates the growth of collagen under the skin and tightens underlying skin - it avoids damage to the surface skin cells. Many types of laser (including IPL, Q-switched Nd:YAG laser and pulsed dye laser) are non-ablative.

What is laser resurfacing?

Laser resurfacing usually involves having laser therapy over a larger area. It can be done with an ablative laser or non-ablative laser.

Fully ablative laser resurfacing involves treatment of the entire area of skin with an ablative laser. Fractional laser resurfacing, or fractional photothermolysis (Fraxel), treats just a fraction of the skin. The percentage of skin that is treated can vary from 2 to 95 per cent. Fractional laser resurfacing can be done with ablative or non-ablative laser therapy, and often requires several treatment sessions. Amazingly, fractional laser resurfacing can improve the overall appearance of the skin evenly, despite only a fraction being treated.

Both fully ablative and fractional laser resurfacing can be used for cosmetic skin rejuvenation and to treat problems such as scarring (e.g. from acne or burns) and sun damaged skin.

The recovery time is longer following fully ablative laser resurfacing. Non-ablative fractional laser therapy has the fastest recovery time.

What can laser therapy be used for?

A number of skin conditions can be treated effectively with laser therapy. There are also several cosmetic uses of laser therapy, including hair removal.

If you are considering a cosmetic laser procedure, make sure you discuss your expectations and whether you’d be a suitable candidate with your doctor.

Laser tattoo removal

Laser treatment can be used to remove unwanted tattoos. It works by shattering the ink particles from the tattoo into tiny fragments so that your immune system can remove the pigment from the skin.

In general, homemade Indian ink tattoos and black tattoos respond most readily to laser removal. White tattoos do not usually respond to treatment. Red is relatively easy to remove, while yellow, orange, blue and green are more difficult. The wavelength of the laser light beam needs to be changed to treat different coloured ink pigments used in the tattoo.

Multiple treatments are usually needed for removal of tattoos, but newer laser treatments tend to require fewer treatments.

Skin that has been stained from nasal piercing or from iron injections also usually responds well to laser treatment.

Laser hair removal

Laser hair removal uses intense pulsed light (IPL) - a type of non-ablative laser - to remove unwanted hair. The pigment in the unwanted hair absorbs light energy from the laser and converts it to heat, which damages the hair follicles. This stops or delays further hair growth from the damaged follicles.

Hair loss can last months or years, and in some cases is permanent. Multiple treatments are usually needed to start with, and several maintenance treatments may also be needed to remain hair-free. Ingrown hairs are less common with laser hair removal compared with other hair removal techniques.

Laser hair removal works best on thicker, darker hairs, as these hair follicles absorb more light than do smaller, paler hair follicles. It also works better when the dark hair grows on fair skin rather than darker skin. That’s because when there is a contrast between the hair and skin colour, the hair is better able to absorb most of the light, rather than the skin.

Before having laser hair removal, you’ll be asked to trim and shave the hair from the area being treated. This reduces the chances of surface skin damage from burnt hairs.

Ageing and sun damage

Cosmetic laser resurfacing can be used to improve the appearance of:

  • fine wrinkles;
  • crinkly skin;
  • uneven skin tone or texture;
  • sun-damaged skin; and
  • sun-damaged lips.

Ablative laser therapy can be used to treat:

  • freckles;
  • solar lentigines (also called liver spots or age spots);
  • flat, pigmented seborrhoeic keratoses (age warts); and
  • actinic keratoses (also called solar keratoses or sunspots).

Skin problems

Scars from acne, skin injuries, surgery or burns can be treated with fully ablative laser resurfacing or fractional laser therapy to improve their appearance.

Laser therapy can also improve the appearance of spider veins (small, widened blood vessels that are also called telangiectasias or ‘broken capillaries’ and are often seen on the cheeks, nose, chin and legs) and spider naevi (prominent blood vessels that can appear on the face, neck and chest). The type of laser used will depend on where the lesions are and how extensive they are.

Laser ablation can be used to treat rhinophyma, a complication of rosacea that causes the nose to become bulbous.

Birthmarks

Port wine stains are a type of birthmark that most often affects the face but can appear anywhere on the body. This type of birthmark can be treated with multiple sessions of laser therapy, which can lighten the stain significantly. Unfortunately, laser therapy doesn’t work in about 10-20 per cent of cases. Laser treatment of port wine stains often needs to be done under general anaesthetic in children.

Café au lait spots (flat tan or brown birthmarks) can appear anywhere on the skin and are present at birth or appear in early childhood. If you are concerned about how they look, they can be treated with lasers, but results are variable. About half respond to laser treatment. Multiple treatment sessions are needed and the spots can come back after treatment.

Haemangioma of infancy (strawberry naevus) is another type of birthmark that may be treated with certain types of laser therapy.

Is laser therapy painful?

Laser therapy usually feels a bit like your skin is being flicked with a rubber or elastic band. Most adults find the level of discomfort acceptable without any special treatment. However, some people may have a topical anaesthetic cream or gel applied to the skin to reduce discomfort. In some cases, sedation or a general anaesthetic may be recommended. This is usually only needed for children or if the treatment area is very large.

After extensive laser therapy, your doctor or specialist may advise taking it easy after the procedure to let the discomfort and swelling settle. Ice packs and pain relievers may help.

Does laser therapy have any side effects?

There are some side effects associated with laser therapy. Side effects will vary depending on the type of laser used and the size of the area that’s been treated.

Immediately after laser therapy there can be redness and swelling of the treated area. This can be associated with mild discomfort and itching. If you’ve had a minor procedure (such as laser hair removal or non-ablative laser resurfacing) it may only last a few hours. But if you’ve had deeper or more extensive treatment (e.g. ablative laser resurfacing) it can last several months.

Sometimes there also can be temporary changes in skin pigment - skin can become lighter or darker than usual. In people with dark skin, laser therapy can cause loss or unevenness of skin colour lasting several months.

On rare occasions, laser therapy can cause superficial burns, blistering, crusting, infection or scarring.

It may take weeks or even months for your skin to recover after laser resurfacing. Side effects can include dermatitis (inflammation of skin) or a flare up of acne or rosacea. In people who’ve previously had cold sores, reactivation of the herpes virus by the laser can bring on a cold sore.

Talk to your doctor or specialist about the pros and cons of laser therapy before going ahead.

Laser therapy and sun protection

Sun protection is recommended for all people, but you should be especially vigilant about avoiding sun exposure before and after having laser therapy. Laser resurfacing can make your skin more sensitive to the sun for up to a year after treatment.

You’ll need to make sure that the treated skin is exposed to the sun as little as possible and use sunscreen as advised by your doctor or specialist. Your doctor can advise you how long you need to stay out of the sun.

Where can I get laser therapy?

It depends on why you are having laser treatment. If you are having laser therapy for a skin condition or lesion, your skin specialist (dermatologist) can give the laser treatment. It’s important that you never have laser treatment for a medical condition unless it is prescribed and delivered by a medical professional.

Cosmetic laser therapy can be provided by cosmetic surgeons. Any doctor providing cosmetic laser therapy should be specially trained. Some cosmetic laser procedures may be offered at clinics, spas or salons.

If you are considering having cosmetic laser treatment, make sure you check with your doctor beforehand whether it is suitable for you. People with certain medical conditions and who are taking (or have recently taken) certain medicines should generally not have laser therapy.

Licensing and regulation of cosmetic laser providers varies from state to state. What’s important when you are considering laser therapy is that you are aware of the risks and benefits of treatment. You should be careful about cost, as the price will vary between clinics. Use a clinic with a good reputation and make sure that a trained professional is administering the treatment.

Laser hair removal and minor laser cosmetic procedures can be done by nurses and beauty therapists. However, people providing laser therapy generally need to have received special training in this area.

It is also possible to buy your own laser hair removal device to use at home. These devices are generally not as effective at removing hair and may be associated with higher risks. It’s important if you are using one that you follow the instructions to the letter.

References

1. Australian College of Dermatologists. A to Z of skin. https://www.dermcoll.edu.au/a-to-z-of-skin/ (accessed Aug 2018).
2. Royal Children’s Hospital Melbourne. Laser treatment for birthmarks (reviewed Aug 2018). https://www.rch.org.au/kidsinfo/fact_sheets/Laser_treatment_for_birthmarks/ (accessed Aug 2018).
3. Liang Joo Leow. Navigating the disparate Australian regulatory minefield of cosmetic therapy. AFP 2017;46(9):97-8. https://www.racgp.org.au/afp/2017/september/navigating-the-disparate-australian-regulatory-minefield-of-cosmetic-therapy/ (accessed Aug 2018).
4. Pigment disorders (published November 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. http://online.tg.org.au/complete/ (accessed Sep 2018).
5. Paediatric dermatology (published November 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. http://online.tg.org.au/complete/ (accessed Sep 2018).
6. Solar damage and skin cancer (published November 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. http://online.tg.org.au/complete/ (accessed Sep 2018).
7. DermNet NZ. Lasers in dermatology. https://www.dermnetnz.org/topics/lasers-in-dermatology/ (accessed Sep 2018).

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