LASER IN ESTHETIC MEDICINE

MEDICAL: MARIA FLORENCIA VERA MORANDINI

 LASER

The word LASER is an acronym in English that

it means the following:

Light

Amplification by

Stimulated

Emission of

Radiation
SPECTRUM OF LIGHT
 LASER

Electronic device that, based on induced emission, extraordinarily amplifies a light beam
monochromatic and coherent.

Stimulated emission becomes possible by understanding spontaneous emission and the quantum mechanics of matter.
 SPONTANEOUS EMISSION INDUCED BY RADIATION

1916 EINSTEIN. ESTABLISHED THE FOUNDATIONS FOR THE DEVELOPMENT OF THE LASER, BASED ON THE CONCEPTS
ON SPONTANEOUS AND INDUCED RADIATION EMISSION.
 LASER

It differs from the light emitted by conventional light sources due to the following characteristics:

Monochromaticity: The identity of the atom or molecule that is excited determines the wavelength of the radiation.
produced. That is, the laser has only one color.

Coherence: Light can be considered as a sinusoidal wave. The light emitted by a laser has the distinction of being
coherent both temporally and spatially, that is, the waves are in phase both in time and in space.

Collimation: It is a direct consequence of coherence and refers to non-divergence and energy conservation.
properties of light in which the waves are parallel.
LASER
 IPL

They are sources of high-intensity polychromatic light that emit pulsed light across a wide range of wavelengths.
wave, between 400 and 1,200 nm.

The filters or cutting heads are available to selectively act on variable structures at different
depths of the skin.

For example, filters can be changed to match glasses of different calibers and depths.
hair follicles or pigmented cells.
 IPL

They produce their effect according to the principle of selective photothermolysis.

Unlike lasers, which target a specific chromophore with monochromatic light, LIP systems can
to be used to treat both vascular lesions and pigmented lesions simultaneously.

Unlike the laser, the energy loss is greater although the LIP provides greater versatility.
 LASER IN AESTHETIC MEDICINE

Skin texture
Wrinkles
Acne
Epidermis
Stains
Dermis • Hair
• Lesion
Subcutaneous Fat
& Collagen
vascular
Cellulitis and
fat
LASER IN AESTHETIC MEDICINE
SELECTIVE PHOTOTHERMOLOSIS

Anderson & Parrish, Science, 1983

 PRINCIPLES

Spectral selectivity: Choosing an optimal wavelength to maximize absorption by the target and
depth of action.

Thermal selectivity: Choice of pulse duration and energy to maximize tissue target heating
y minimizar el calentamiento del tejido circundante en función del periodo de relajación térmica (y contraste)
between both
 LASER

This technique is based on the selective absorption of a very short pulse of optical energy (IPL or laser) to generate heat and
to restrict it to certain pigmented targets. An essential requirement is that the targets have, for
at certain wavelengths, an optical absorption greater than the surrounding tissue.

R. Rox Anderson and John Parrish

 LASER

During exposure to light, absorption converts radiant energy into heat. The targets begin to transfer
this heat to the surrounding areas that are cooler, mainly through thermal diffusion, but this
the transfer process takes some time (thermal relaxation time of the target) and during the
exhibition the heat is initially circumscribed to the target.

R. Rox Anderson and John Parrish

Different effects can be produced in the tissue: Photo-stimulation, Photodynamic reactions, Reactions
photothermal and photomechanical.

The attainment of these effects will depend directly on 3 main factors: The wavelength of emission,
pulse duration (associated with the thermal relaxation time of the structure being acted upon) and creep of
energy.

The size of the spot, pulse frequency, power, and power density are also other parameters.
important to ensure safety and results.
 PRINCIPLES

Selective destruction of the target chromophore (color)

The exposure time of the radiation on the target must be shorter than the thermal relaxation period TRT.

TRT represents the time in which the target loses 50% of its heat.
 SELECTIVE PHOTOTHERMOLOYSIS

Anderson and Parrish (1983) defined this principle by which a determined structure or chromophore,
it can be selectively destroyed by light, minimizing the effect on the structures
neighbors.

It consists of the selective absorption of light by chromophores - which is a substance capable

to absorb energy, such as melanin. In the case of hair removal, the large
melanin concentrations present in the hair absorb the heat from the laser, causing its
destruction by thermal effect, without damaging the surrounding tissue.
SPECTRAL SELECTIVITY
The wavelength

It is measured in nm (nanometers–10-9m) and represents the band of the electromagnetic spectrum where it emits each

one of the lasers or light systems.

Most are within the ultraviolet, visible, and infrared bands. The wavelength will influence:

The optical penetration of that radiation in the different tissue structures.

The selection of the chromophore or target structure to act upon.

 LASER

The wavelength is an essential parameter, as it determines the capacity to absorb energy.

luminescence from the target (which has chromophores – such as water, melanin, and blood-) and the corresponding
selectivity of treatment.

Many of the targets that are attempted to be addressed are located beneath the surface of the skin, and, due to the
Dispersion, the wavelength plays an important role in the depth of penetration of energy.
incident light.

The emission band with lasers is very narrow, whereas in incoherent light systems (IPL) the
The emission band is quite broad, so the width of this band must be specified.
 THERMAL SELECTIVITY

Pulse duration, or pulse width

time interval during which energy is supplied.

To ensure the treatment is effective, the pulse duration must be shorter than the thermal relaxation time (TRT) of
objective that will be addressed.
 Thermal Selectivity

The TRT is the time required for the energy absorbed by the target to propagate to the tissue.
surrounding. This is the time it takes for a structure to cool to half of the temperature
maximum reached after receiving the light energy from the laser and transforming it into heat. For example, if
It reached 60ºC, the TRT will be the time it takes to reach 30ºC.

The duration of the chosen pulses must be less than this TRT to destroy the chromophore, but must
balance with the TRT of adjacent structures to avoid damaging them. The TRT of the epidermis is 3 to 10 ms.
while in the case of hair follicles, TRT in seconds is equal to the square of the diameter in
millimeters.
 Cooling Relaxation Time

Time required for an object to cool to 50% of its original temperature.

Reaching the thermal conductivity that depends on:

Size

Geometry

Material (concentration of pigment or melanin, blood, water).

Gel or active cooling accelerates the cooling of the skin

 Thermal Selectivity

The fluency or density of energy

It is the light energy applied per unit area to heat the target, measured in Joules/cm2.
It is assumed that sufficient energy must be supplied during the treatment to produce the desired effect on
the diana.

The maximum flow that a device can deliver is directly determined by the power (Watts [W])
of the same, the greater the power, the greater the capacity to deliver high flows in a short time (understood as little

time equal to or less than the thermal relaxation time where we necessarily have to
to work to produce the desired effect with the least possible damage to the surrounding tissue.
 LASER

The power of emissions is the energy emitted in one second, having the unit watt (W) or submultiples.
of the same (mW) 1W=1Joule/Second.

Power indicates the energy density that can be delivered per unit of time.
 PARAMETERS

Joules/cm2: energy density supplied over time in a given area.

Pulse width: duration of the 'useful' pulse delivered. It can refer to mseg or nseg.

Spot: size of the window or actual unfocused area of the light beam output

Wavelength: determines the 'part' of the specificity of the treatment and characterizes the technology.

Extras: cooling, auto-calibration, durability of heads or lamps, etc.

 PARAMETERS

The size of the spot

It is the diameter of the beam of light projected onto the surface of the skin.

This parameter affects the treatment zone and the depth of action.

With a small spot size, it is easier for the team to deliver high energies, but the penetration is very
scarce due to light scattering; on the contrary, with a larger spot size a
team with the highest power in Watts to achieve adequate flow but depths of action are achieved
correct measures to ensure security and effectiveness in the results.
 PARAMETERS

Pulse frequency

It is the number of pulses emitted per second and determines the speed of the treatment.

Use hertz (Hz) as the unit.

 PARAMETERS

Power density

It is the relationship between the actual output power of the emitter and the surface area of the beam that it emits, isn't it?

of the total treatment area.

Its unit is watts/cm2 or submultiples of it (nW/cm).

It provides an idea of the actual distribution of energy in the given area per unit of time.
 Laser / Light Tissue Effects

Reflection Dispersion

Transmission Absorption
 INCIDENCE OF LIGHT ON THE SKIN

The Grothus-Draper law states that there can only be a tissue effect if light is absorbed.

Neither the reflected light nor the transmitted light has a tissue effect.

Reflection: Approximately 4-6% of light is reflected at the level of the stratum corneum.

Absorption: The absorption of photons is described by Beer’s law. This states that the intensity of light
The intensity depends on a specific wavelength that is transmitted through the tissue.
initial, of the penetration depth and extinction length (the distance at which it is absorbed
90% of the ray). Without light absorption, there can be no effect on the tissue. When the photon is absorbed
for a target molecule or chromophore, all its energy is transferred to that molecule. The chromophores
Important endogenous substances are melanin, hemoglobin, water, and collagen.
 INCIDENCE OF LIGHT ON THE SKIN

Dispersion: In the skin, this is largely due to the collagen in the dermis. Since the molecule of
collagen is similar in size to the wavelength of visible light and near infrared, the dispersion is
mainly forward, but there is enough scattering backward to increase the density of
energy in the superficial dermis. Two other types of dispersion occur in the skin: weak dispersion throughout the
directions and that caused by objects larger than the incident light, which also moves forward. The
dispersion is important because it quickly reduces the flow of energy available for absorption
by the chromophore target and, from there, the clinical effect on the tissue. The dispersion decreases with wavelengths
larger ones, making them the ideal vehicle to mark deep dermal structures such as follicles.
hairy.
 INCIDENCE OF LIGHT ON THE SKIN

Transmission: The residual light is transmitted to the subcutaneous tissue. This largely depends on the length of
Waves, with short wavelengths (300-400nm), dissipate and penetrate less than 0.1mm. The wavelengths
Waves between 600-1200 nm are introduced more deeply because they dissipate less.
LASER VS. IPL
TYPES OF LASER
ACCORDING TO THE ACTIVE MEDIUM
UTILITIES
UTILITIES
UTILITIES
USEFULNESS
LASER PENETRATION
LASER PENETRATION
 LASER

DETAILED CLINICAL HISTORY.

DETAIL MEDICATION TAKING.

DETAIL ALLERGIES.

INFORMED CONSENT.

PHOTO.

RECOMENDACIONES.

FPS.
 LASER

TREATMENTS
LASER IN AESTHETIC MEDICINE

UNATTRACTIVE HAIRS/ HAIR REMOVAL

 LASER IN AESTHETIC MEDICINE

UNSIGHTLY HAIR/ HAIR REMOVAL:

It reaches the follicle safely, affecting the bulb without damaging the skin, altering its growth.

MELANIN: CHROMOFOR.

Anagen Phase.

Duration: depends on the area size, hair type, state of the active growth cycle, amount of
melanin of the follicle.

•LASER IPL, DIODE, ALEJANDRA LASER, RUBY LASER, Nd:YAG LASER

 LASER IN AESTHETIC MEDICINE

The Laser or IPL produces a powerful beam of highly focused light.

concentrated.
Laser energy is converted into heat in the pigment of
follicle, which is destroyed, thus preventing the hair
grow back.
All this, without damaging the surrounding skin.
The hairs in the anagen phase are the most sensitive to light.
laser, since at this stage they contain abundant melanin.
Therefore, it is in the active growth phase when the laser has
greater effectiveness.
hair follicle
LASER IN AESTHETIC MEDICINE
 LASER IN AESTHETIC MEDICINE

WHAT TO DESTROY?
 LASER IN AESTHETIC MEDICINE

HAIR CYCLE

Determine the length

end of the hair
 LASER IN AESTHETIC MEDICINE

Each laser pulse reaches several follicles at the same time. However, since not all hairs are present
In the same growth phase, several sessions are necessary, with intervals of between 4 and 8 weeks.

Normal Follicle After Laser

LASER EN MEDICINA ESTETICA
 CARES

ENABLED ENVIRONMENT.

CLEAN THE AREA TO BE TREATED.

NEUTRAL GEL.

COVER TATTOOS, NEVUS, WITH TAPE

WHITE OR WHITE PENCIL.

SUNGlasses.

DO NOT PASS THROUGH IRRITATED AREA OR

INJURED.

Do not pass through snow or injuries

DISPLASIAS.
 LASER IN AESTHETIC MEDICINE

Power

Pulse Width

Spot or head size

Cold System

ASSOCIATED SIGNS (COLORATION)

. TYPE OF PULSE
. FUENCIA
. ENERGY
. TIME
LASER IN AESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
 TIME BETWEEN SESSIONS

Facial: 4-6 weeks.

Trunk: 8-10 weeks.

Extremities: 10-12 weeks

Or within the first 7 days when hair growth is observed (anagen)
early
 TAKE INTO ACCOUNT

The color of the skin

The depth of the hair follicle

Hair color

Diameter of the hair

Hair density

Hair growth phase: Anagen

 DIFFICULTY

High phototype or newly tanned skin.

Fine and lightly pigmented hair.

Complex anatomical regions.

Androgen-dependent areas.

Paradoxical effect.

Miniaturized hair.
 EXPECTED ANSWER

Smell of burnt hair

Perifollicular erythema

Perifollicular edema
 EFFECT OF SPOT SIZE

BIG SMALL

The larger spot allows for lower flow levels.

Smaller spots allow for increased flow.
ADVERSE EFFECTS
LASER IN AESTHETIC MEDICINE
ADVERSE EFFECT
LASER IN AESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
 LASER IN AESTHETIC MEDICINE

Vascular and Pigmentary Lesions

 LASER IN AESTHETIC MEDICINE

Vascular and pigmented lesions:

Photoaging and acquired hyperpigmentation.

Solar lentigines, keratosis, microvarices, telangiectasias,

angiomas, dilated capillaries of rosacea, malformations
low flow vascular.

•CHROMOPHORE: MELANIN, HEMOGLOBIN

Oxyhemoglobin.

LASER IPL, Nd YAG: 1064nm, DIODE 810 nm.

 TREATMENT MECHANISMS

The wavelength of 755nm selects hemoglobin.

Oxyhemoglobin in the red vessels

Deoxyhemoglobin in the blue vessels

Transmits heat to the wall of the glass.

For effective damage, enough heat must be transmitted to the entire vascular wall.
 LASER IN AESTHETIC MEDICINE

Thermal Relaxation Time (TRT)

Defined as the time required for 50% or more of the absorbed energy to diffuse in the tissue
surrounding.

To effectively heat the walls of the vials, a longer pulse duration may be necessary and may be
greater than the TRT of erythrocytes.
 LASER IN AESTHETIC MEDICINE

Thermal Damage Time (TDT)

It is defined as the time required to heat a specific structure to a harmful temperature.

The TDT can be significantly longer than the TRT.

LASER IN AESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
 ALEXANDRITE LASER

The following benign pigmented lesions can be treated with the

wavelength 755nm:

. Hyperpigmentation

. Lentigos

. Moles (Freckles)

. Café con leche

 ALEXANDRITE LASER

Spot 18 mm / 24 joules / 1 session

ALEXANDRITE LASER
LASER IN ESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
 LASER IN AESTHETIC MEDICINE

Sclerotherapy is the gold standard for treating veins in the legs.

The wavelengths of 755nm and 1064nm can work very well with your
correct parameters

The smaller veins of 2mm respond better.

 VASCULAR–1064NM

Facial cups
Only the spot size of 1.5 mm should be used on the face.

•As a final point, erythema should appear and the vessels should disappear.

Veins in legs
The cups must disappear

Cat scratch-like spots, welts or intense redness may appear after about 5 minutes.
Pigmentary treatments with Candela
Spot 18 mm / 18 joules / 1 session
 LASER IN AESTHETIC MEDICINE

COMPLICACIONES: costra, eritema, ampolla, infección, ardor, hipopigmentacion, hiperpigmentacion. Cicatriz

keloid, scar.

CAUTIONS: SPF.
Humectants.
Moisturizers.
Skin lighteners.
 LASER IN AESTHETIC MEDICINE

FACIAL REJUVENATION
 LASER IN AESTHETIC MEDICINE

FACIAL REJUVENATION

Superficial removal of the skin down to the papillary dermis with photocoagulation or vaporization.

Photodamage, pigmentary alterations, elastosis, keratosis, superficial wrinkles.

•For more depth, up to reticular dermis, in rhinophyma, xanthelasma, tumor excision

anexial lesions, correction of acne scars, deep wrinkles.
 LASER IN AESTHETIC MEDICINE

TYPE OF LASER

Carbon dioxide

Erbium: YAG
 LASER IN AESTHETIC MEDICINE

PROCEDURE

Prepare the area to be treated.

•Control depth (300 mJ), number of passes, and density.

After the sweep, the skin shows a pink coloration (papillary dermis)

Pale yellow color (reticular dermis) DO NOT continue.

 LASER IN AESTHETIC MEDICINE

The thermal injury stimulates the tissue to initiate a healing response.

The depth of the thermal injury depends on the wavelength.

Heat causes a thermal injury to collagen and can make

possible contraction
 LASER IN AESTHETIC MEDICINE

POST LASER

Improve and speed up the skin restoration process.

MOISTURIZERS:

100% Squalane Oil (stimulates healing).

Hyaluronic Acid

ANTI-INFLAMMATORIES AND SOFTENERS:

Chamomile.
Squalene (vegetal derivative extracted from the horse chestnut)
vasoconstrictor.
Vit. K 1% (accelerates the reabsorption of blood extravasation).
 LASER IN AESTHETIC MEDICINE

MASKS
DEPigmenters
Manzanilla-Tilia-Calendula-Sambucus.
Hydroquinone 2-5%
MOISTURIZER Bearberry extract 3-7%
Kojic Acid 1-2%
Coconut, Aloe Vera, Rosehip. Phytic Acid 0.5-2%
Vitamin C
(ANTI-INFLAMMATORY)

Hyaluronic Acid, Coenzyme Q, L-carnitine, Vit. A

and E. (ANTIOXIDANTS)

SUN PHOTOPROTECTION !!
LASER IN AESTHETIC MEDICINE

IPL
 LASER IN AESTHETIC MEDICINE

IPL

Intense incoherent lamp to produce energy with multiple wavelengths.

It is not characterized by being monochromatic, by having collimation, or by spatial and temporal coherence.

Wavelength of 580nm and 980nm.

 PARAMETER ADJUSTMENTS

Depending on the skin type and the target (contrast)

More aggressive parameters:

High fluence j/cm2

Duration of short pulses

Short pulse delay

Reduced number of sub-pulses

•Filter with shorter wavelength

Soft parameters - vice versa

 SPOT SIZE EFFECT

The penetration depth depends on the size of the

SPOT

Principal factor: dispersion.

Size of the SPOT

Small penetration depth

“Lost” photons to the great dispersion

LARGE SIZE SPOT

Accumulated photons by scattering

Greater depth of penetration

 IPL

2mm 5mm
 ADVANTAGES OF IPL

Broadband spectrum.

Spectrum control for greater versatility and security

Pulse optimization

Multiple pulses

•Tiempos (duracion, delay)

Fluency

Spot size

Large areas

Adjustable penetration depth

 IPL

INDICATIONS

. Hair removal.

. Rejuvenation.

. Photoaging.

. Vascular injuries
IPL
IPL
IPL
IPL
 IPL

ENABLED ENVIRONMENT.
CLEAN THE AREA TO BE TREATED.
NEUTRAL GEL.
COVER TATTOOS, SCARS, WITH WHITE TAPE OR
WHITE PENCIL.
Sunglasses.
DO NOT PASS THROUGH IRRITATED OR INJURED AREA.
Do not pass through snow or dysplastic lesions.
LASER IN AESTHETIC MEDICINE

TATTOO REMOVAL
 LASER IN AESTHETIC MEDICINE

TATTOO REMOVAL:

The laser works at different wavelengths, depending on the pigment to be removed.

Different colors: blacks, greens-blues, reds, yellows, and oranges.

Types: Nd-YAG.
Q-switched, Doubled frequency Nd: YAG. (1064 nm black tattoo), (532nm red, orange, yellow)
Alexandrite laser. (black, green, and blue)
Q-switched Alexandrite Laser.
Laser ruby. (black, blue, and green)
LASER IN AESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
LASER IN AESTHETIC MEDICINE
 LASER IN AESTHETIC MEDICINE

TREATMENT

Previous peeling?

Prepare the area to be treated, anesthesia.

Between 4 to 10 sessions, with an interval of 4

6 weeks.

Apply healing powder, cream

antibiotic and anti-inflammatory.
 LASER IN AESTHETIC MEDICINE

CONTRAINDICATIONS

Patients taking oral tretinoin should wait at least 8 months.

Patients taking photosensitive medications (Antibiotics / antimicrobials: tetracyclines, fluoroquinolones, acid

nalidixic sulfonamides, trimethoprim. Antifungals: griseofulvin, ketoconazole. Cardiovascular agents: amiodarone, captopril, diuretics
(furosemide, hydrochlorothiazide)

Patients with active herpes or pustular acne.

Patients with vitiligo or collagen diseases, such as lupus, scleroderma.

Skin subjected to burns or radiation therapy

History of keloid and hypertrophic scarring.

 LASER IN AESTHETIC MEDICINE

Different types of lasers can be combined with others.

treatments and devices.

The results will be enhanced when combined.

correctly.

Treatment protocols improve outcomes.

 LASER IN AESTHETIC MEDICINE
The tissue effect is caused by:

The influence of laser energy heating a specific chromophore.

2. The diffusion of that heat to neighboring structures.

The extent of thermal damage is determined by:

1. The increase in temperature achieved, which determines the damage to the target we are aiming at.

2. The period of time that the particle is heated, which is influenced by the conductivity of heat.

This extent of tissue damage will depend on:

The energy density applied by the laser -J/cm2.

2. The duration of the pulse - msec.

3. The thermal conductivity to other structures - TRT.

 LASER IN AESTHETIC MEDICINE
The concept of selective photothermolysis stems from an understanding of the tissue interactions triggered by the laser.

The specific absorption of this light generated by a laser with certain characteristics is necessary to achieve an effect
tissue.

The ultimate goal is to direct energy precisely to a specific chromophore in the skin without causing damage to the adjacent tissues.

There are three variables to achieve this microscopic precision:

The wavelength must be absorbed more avidly by the specific object than by the adjacent structures.

2. The flow must be high enough to thermally alter the object we are targeting.

3. The duration of the exposure must be less than the time needed for the object to cool down.
QUESTIONS?