Ever since laser surgery was first used for tattoo removal back in 1962 the tool has found itself into an ever-growing list of applications in medicine. In cosmetics, lasers have been used to remove unwanted dark spots, spider/small varicose veins, hair and tattoos. Now, with the advent of Q-switch Nd:YAG laser treatments, these procedures are now better and safer than before.
Light Amplification by Stimulated Emission of Radiation.
You may be wondering how lasers are able to selectively to destroy target sites. This is possible because materials absorb light based on its colour; and skin tissue and pigmentation are no exception.
Lasers in cosmetic procedures are generally used to target and damage tissue and/or pigments through photothermal or photomechanical action; that is, to selectively burn off or fragment targeted tissue respectively.
This forms the basis of all laser removal treatments.
Different coloured pigments are affected by different wavelength lasers.
As a general rule, dark colours like melanin (black, brown skin pigmentation) absorb a wide spectrum of light, so most lasers have no problem in its targeting. Ruby and alexandrite solid-state lasers have wavelengths of 694 nm and 755 nm respectively and thus are useful in these applications.
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Continuous Wave vs Q-Switch Lasers.
1. Continuous Wave Lasers
Before Q-Switched lasers became commercially available back in the late 1980’s, laser removal treatments were performed solely with continuous wave lasers. These lasers rely on photothermal action, or burning, to breakdown targeted tissue or pigments.
However, photothermal effects are ‘slow’ acting, giving more time for the laser light to be reflected and scattered – often into the surrounding tissue. This is known as ‘non-selective’ targeting and results in unwanted damage to surrounding tissue, which manifests itself as scarring on the skin and skin tone alteration.
2. Q-Switch Lasers (pulse laser)
Q-switching is method of transforming continuous wave lasers into short but powerful bursts of laser light, or pulses, measured in nanoseconds.
This is achieved by reflecting a laser light to and fro two mirrored surfaces inside an optical resonator (a special container housing the solid-state laser medium) to ‘saturate’ the laser.
When a high-enough saturation is reached one of the mirrored surfaces, which is a variable attenuating surface (which could be a shutter, spinning mirror prism or kerr cell) is turned off or removed. The stored laser light then ‘floods’ out in powerful pulses and at a lower rate of repetition.
Q-switch lasers work by photomechanical action – that is, by delivering an intense amount of energy to target that it literally explodes, resulting in a tiny but (relatively) violent shockwave (called photoacoustics) that rupture and disrupt adjacent tissue/pigments. Therefore, pulsed Q-switch lasers precise, minimizing damage to healthy tissue.
The precision of Q-switch lasers makes it the universal laser for all cosmetic and medical applications, with Q-switch Nd:YAG laser treatments being the most versatile.
Q-switch Nd:YAG lasers the most versatile choice.
Nd:YAG, or neodymium-doped yttrium aluminium garnet produce lasers with a typical wavelength of 1064 nm, which is tunable to 532 nm by doubling its frequency.
The advantage of Q-switch Nd:YAG laser treatments utilizing a 1064 nm laser is its ability to penetrate deeper into the skin without affecting non-targeted areas since it be absorbed by lighter coloured tissue.
If needed, an Nd:YAG laser can also be tuned into the 532 nm range to for actions taken on the surface of the skin.
In tattoo removal, the Nd:YAG laser is suitable for removing red pigments which are slightly out of reach of ruby and alexandrite lasers.
Laser removal of dark spots, spider veins and other unwanted marks on skin.
To treat spider/small varicose veins, a laser is used to heat and thus damage the veins, causing it to form scar tissue and closes. Cut off from its blood supply, these veins die off and is completely removed by the immune system over a couple of years.
Again, Q-switch Nd:YAG laser treatments operating at 1064 nm are particularly useful for reaching spider and small varicose veins located far underneath the epidermis.
It may take up multiple sessions to complete, with about 6 to 12 week recess periods in between. Larger veins require a more complicated procedure, though.
Dark spots are better treated with 532 nm laser as it is located close to the surface. The pigments are heated and broken down into small fragments which is also then carried off by the immune system.
Recovery time is quick, and patients will soon be up and about in no time.
Hair removal by Q-switch Nd:YAG laser treatments.
Most of the time hair removal treatments are used to target and reduce hair around the legs, underarms, upper lip, chin and bikini line.
Melanin pigment typically characterizes the chromophore (colour) of hair follicles. Therefore in order to target hair follicles the lasers are set to target melanin.
Unfortunately, melanin is also found in epidermis surrounding hair follicles which also become targets for the laser. To minimize damage the skin around the treated area is cooled with ice, gel, or cool airflow.
However, the photomechanical action used by Q-switch Nd:YAG laser treatments and the resulting photoacoustic shock isn’t enough to completely disrupt hair follicle growth, and thus doesn’t remove hair completely. Multiple sessions are needed to maintain hair-removal.
Remember how lasers target based on how well its target site absorbs light? This means that highly contrasting hair and skin colours determine how well the treatment would be, with dark hair and light skin giving the best results.
Before and after surgery effects.
Treatment with lasers can be painful – and the use of anaesthetics, topical or injected, is recommended. Know that some people are allergic to certain topical anaesthetics so it’s best to ask a doctor for advice!
Laser treatments also leave skin irritated, and may cause changes in skin tone, especially the whitening of darker skin.
It’s best to avoid exposing the skin to sun right after treatment. If exposure is not avoidable then be sure to apply a dose of sun screen SPF 35 or above.
Redness and irritation should subside after a few hours. In the meantime an application of gel or creams will help soothe it. It is best to keep the treated area clean and dry for 4-5 days and not touch it except for applying soothing creams.
And never perform any laser removal treatment if under antibiotic treatment!
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