LASER Basics 101

Special thanks to Dr John H Smith, American Board of Plastic Surgery notes/lectures.

The term “LASER” originated as an acronym for “light amplification by stimulated emission of radiation,” and has a come a long way since it was first introduced to the market. I will overview 13 different forms of lasers.

The following skin perfecting light based devices target different cells to reduce or eliminate pigmentation, scars, redness, wrinkles and textural issues of the skin (1-3).

**best for refining and minimizing pores and fine lines

Brand Name: Clear + Brilliant

How it works: Creates miniscule holes in the skin to reveal fresher, smoother skin as it heals.

What to expect: Skin will look and feel smoother and boast a healthy glow in one to two days.

When to do it: A day or two before a big event

The Recovery: Next to none, but the 30 minute treatment can leave you a little red for about an hour.

**best for hair removal

Brand Names: LightSheer Duet, GentleEase, Ultrawave, Elos

How they work: Sends a beam of pulsating energy to skin that’s absorbed by the melanin in the hair follicle to kill the base of the root, which stops hair production. If your hair is grey or light, laser hair removal may not work since it will not recognize the colour.

What to Expect: Each treatment (you’ll need a series) feels like a rubber band snap. Once you have completed the entire treatment series, skin will be free of any hair. Annual touch-ups may be necessary. Up to 10% of people might have paradoxical excessive hair growth.

When to do it: In the winter when your skin is not tan.

The Recovery: Not much other than some redness and bumpiness around the follicle.

**best for lightening pink and red pigment in the skin

Brand Names: Vbeam, Cynergy

How they work: Relies on pulsed dye energy to pick up the red and pink pigment in broken capillaries, scars, redness and ruddy complexions to make the skin more uniform in colour.

What to Expect: Pulsed-dye lasers feel like a rubber band snap on the skin. They can cause some slight bruising to the treated areas. You’ll notice an immediate decrease in broken blood vessels, less redness and a softer texture. Three to five treatments are recommended.

When to do it: Anytime

The Recovery: None, although some patients notice slight bruising

Non Ablative lasers allow you to treat minor skin issues like tone and texture without the prolonged healing that an ablative laser requires. There may be some redness, but you’ll be able to go about your regular daily routine. These lasers are ideal for those who want to gradually transform their skin (4-6).

**best for improving skin texture, minimal pigmentation, redness, broken capillaries and hair removal

Brand Names: Photofacial, Fotofacial, Limelight

How they work: A beam of high energy light is transmitted, infiltrated down in to the skin tissue where it is absorbed.  Although IPL is technically a light, when used for pigment problems the gift is absorbed by melanin; if it’s treating broken capillaries, the blood absorbs the light.

What to expect: IPL feels like a quick snap of a rubber band on the skin. A series of treatments is often recommended. Results can last for a few years as long as you take care of your skin and avoid the sun.

When to do it: Anytime

The Recovery: Skin may look red after treatment. Four to seven days after, the treated areas will darken, scab and fall off.

**best for erasing tattoos

Brand Names: Picosure, RevLite, Accolade, TriVantage

How the work: Hones in on pigment in the tattoo to lift the colour up from the skin. The darker the tattoo dye, the easier the tattoo is to treat.

What to expect: You’ll need a course of treatments (eight to 20 depending on how dark the tattoo is). Older tattoos take longer to treat and are harder to erase. There may be some crusting or swelling that lasts three to seven days. By the end of the treatment your tattoo will be drastically lighter or completely erased.

When to do it: Anytime

The Recovery: Some crusting or swelling for three to seven days.

**best for retexturing the skin, evening out mild acne scars, wrinkles and discolouration on the face, hands, chest and neck.

Brand Names: Fraxel Dual, Harmony XL, Pearl by Cutera

How they work: Damages small columns of skin, safely injuring skin so it heals faster.

What to expect: Skin will be numbed (you can ask for an oral sedative), so you’ll feel less during the treatment.

When to do it: In the middle of the winter. You don’t want to be in the sun at all after this laser treatment.

The Recovery: Your skin may be pink or red and will feel rough (like sandpaper) for two to three days afterward. You may experience some pain, redness and rawness and will want to stay home for about three days. Treated areas need to be kept moist as the skin is healing.

*best for firming loose skin

Brand Name: Ulthera

How it works: Making use of ultrasound energy, this treatment works to lift and tighten loose skin around the eyebrows, on the neck and under the chin by stimulating collagen and the deep support structure of the skin. The outer layers of the skin are not harmed or damaged in any way, so there’s no downtime.

What to expect: Typically, just one treatment for Ulthera , which takes 60 to 90 minutes, is needed. Small amounts of focussed ultrasound energy helps prompt new collagen to be made. Ultra therapy is said to be somewhat uncomfortable and requires pain medication or anesthesia.

When to do it: Anytime

The Recovery: With Ulthera the skin may be flushed or red and there could be some swelling or tenderness, which will subside quickly.

Ablative Lasers are the big sisters to their non-ablative counterparts, going deeper into skin to correct damage, which is why the healing process is longer. Since these are more aggressive lasers, you will need anesthesia during the treatments. For extreme sun damage, texture issues and more stubborn lines, wrinkles, discolouration and spots, an ablative laser should be chosen (8-10).

*best for diminishing pigmentation and wrinkles as well as resurfacing skin

Brand Names: Naturalase Er, Lutronic Action

How they work: Erbium lasers work on the top layers of the skin to vaporize trouble spots.

What to expect: Topical anesthesia will be applied to your skin before the treatment. The effects on pigmentation are good since the entire surface of the skin is resurfaced.

When to do it: Anytime

The Recovery: There is minimal downtime- about three to five days- during which time skin will be red and possibly swollen.

*best for eliminating severe lines, wrinkles, pigment, sun damage, deep acne and traumatic scars

Brand Names: Fraxel re:pair SST, Pixel CO2, Mixto CO2, Max FX, Active FX

How they work: Uses small columns of fractionated energy to abate areas of damage Tiny wounds are created in the skin and the surrounding skin helps produce new collagen and elastin. The laser remodels the collagen, which is why it produces such drastic results.

What to expect: You’ll be given anesthesia so you won’t feel the treatment. Your skin will be extremely red, swollen and oozy (this starts immediately after and continues for three to seven days). It can take a few months to up to one year to see somewhat tighter skin that’s brighter with fewer wrinkles.

When to do it: In the winter when your skin isn’t tan.

The Recovery: Plan for seven to 14 days to recover. The skin will start to crust during the first week. The skin is open to as it heals so use a mild cleanser, healing ointment and zinc- based sunscreen.

*best for resurfacing the skin

Brand Names: Fraxel re: fine, Fraxel Dual, Pixel Perfect

How they work: Fractional Resurfacing lasers lead to smoother skin by inciting collagen production. Only specific areas of skin are safely damaged creating thousands of minute columns, removing damaged surface cells and penetrating down to the dermis. The surrounding skin is left intact.

What to expect: You may not feel much during the laser besides some stinging or snapping since the anesthesia is used. Three to five treatments may be needed.

When to do it: In the winter when your skin isn’t tan.

The Recovery: Skin will be red with some swelling and a temporary grid mark from the machine head for a few days. Once the skin is healed it will be smoother and more even.

Non-Invasive body contouring gives options to those who do not want surgery but still want results. While NOT technically a laser, these options often fall under the laser category (11-13). They work to tighten, tone and smooth the body.

*best for reducing cellulite

Brand Names: VelaShape, VelaSmooth, SmoothShapes, Endermologie, TriActive

How they work: Anti-cellulite laser treatments temporarily smooth out dimpled skin by sending energy to the tissue to break up the composition of fat cells.

What to Expect: It is said to feel like a deep tissue massage with more heat. There may be prolonged warmth or redness after each session (four to 10 may be needed). Though you may see improvement, the results are NOT permanent. Maintenance sessions are necessary to keep cellulite away.

*best for melting fat

Brand Name: CoolSculpting

How it works: Treats fatty pockets by chilling the fat to eliminate it. It uses a vacuum applicator to draw the tissue into a receptacle and extracts heat from the fat cells to cool them, which causes them to die. Once the fat cells crystallize, they break down without causing damage to the collagen, elastin or skin.

What to expect: Set aside at least one to two hours for this treatment, which feels like some pressure and intense cold. You may be sore, bruised and numb for two weeks. You’ll see a reduction in fat in the treated area after one session. Once the fat cells are eliminated , they wont return and you shouldn’t gain wight in the treated areas as long as you follow a healthy diet and exercise plan. However, 750 / 3 million people may experience shelving or paroxysmal  adipose hypertrophy.

*best for tightening up loose skin

Brand Names: Accent Your Body, Thermage, Exilis, PelleFirm, TruSculpt, Fotona Intimilase

How they work: Sends radio-frequency energy to the deep layers of skin to heat it up and produce new collagen while tightening.

What to expect:  Each machine feels different- some get hotter than others- but overall, there’s minimal discomfort and some warmth. A series of treatments are needed to notice a change.