Laser Treatments

Laser therapy is used to treat many dermatological conditions from excessive hair growth, blood vessels and tattoos -- to name just a few. Unfortunately, many patients think of lasers as almost magical, but there are limitations to what they can achieve, especially in brown skin. Laser stands for Light Amplification by Stimulated Emission of Radiation, which means light is amplified (intensified) using a gas, liquid, or solid medium (that supplies electrons) that stimulates the emission of radiation (energy). The intensified laser light then targets a component of the skin called a chromophore. Chromophores may be melanin, hemoglobin (blood), water, or even tattoo ink. Light is divided into different wavelengths and specific wavelengths target certain chromophores. When a specific wavelength of light is absorbed by the chromophore, a reaction occurs that generates heat. In turn, the heat destroys the chromophore. In the case of facial hair growth, the laser [Nd:YAG laser (the medium is neodymium-yttrium-aluminum-garnet) or the diode laser], targets the melanin pigment in the hair, heats the hair and destroys it.

When lasers are used to treat skin of color, the laser light travels through skin, which has a great deal of melanin. This melanin may absorb the laser light, become heated and subsequently injure or destroy the skin cells. In the case where light reaches its intended target and is absorbed by the chromophore, the heat generated may diffuse into surrounding skin, again injuring or destroying the skin cells. Laser light has the potential of causing several different types of skin injury, including blistering, burning, scarring, or discoloration (light patches or dark patches) in the skin. Given our increased melanin content, as explained above, individuals with brown skin are at increased risk of developing side effects from laser therapy. Therefore, laser should only be performed by a physician experienced in laser treatment and also one who has specific experience treating brown skin. A new generation of lasers have been developed that generate less damaging heat (long pulse lasers) and that efficiently cool the skin (sapphire cooled tip, cryogen spray, or cold air flow). These lasers are most appropriate for African, Asian and Latina skin. Performing test spots (small areas of skin on which the laser is tested) to determine how your skin will react to the laser is another way to ensure safety with your laser treatment.

Lasers
There are many different types of lasers that have been developed and it is important to understand which lasers are best for which procedures. Your dermatologist will decide which laser best suits your needs. In general, in brown skin, hair removal is best accomplished with the long pulse diode and long pulse Nd:YAG lasers; tattoo removal with the Q-switched Nd:Yag laser; skin discoloration and blood vessels with the long pulse Nd: YAG, Pulse Dye or ILP lasers; and wrinkles and acne scars with non-ablative ILP lasers. The list below highlights the most common types of lasers and their uses.

Type

Example

Uses

Compatible Skin type

Q-switched Nd:YAG(1064 nm)

Long pulse Nd:YAG

SmartEpil

same as above

Skin pigmentation, including lentigines and tattoos.

Laser assisted hair removal and vascular lesions.

May be used to treat all skin types

May be used to treat all skin types

Long pulse Diode

(800nm- 810 nm)

Light Sheer

Laser assisted hair removal

Can be used to treat all skin types

Intense Pulsed Light (IPL)

Quantum

Red and brown pigmentation, skin texture, blood vessels, facial lines and acne scarring

Can be used to treat all skin types, including skin of color.

 

Laser-assisted Hair Removal
Women have long battled with unwanted body and facial hair, which is often embarrassing. For any woman sick of constantly shaving, plucking and waxing, not to mention depilatories and the long and often cumbersome process of electrolysis, laser assisted hair removal is an important option. Today lasers can be used to permanently reduce not only facial hair, but also hair from the underarms, bikini line, and most other areas of the body. It is important to realize that to reduce hair growth, multiple laser treatments are necessary. Typically, it takes from 4-6 laser treatments because hair is only removed during its growth cycle. Since all hairs are not in the same phase of the cycle, more than one treatment is necessary to permanently reduce the hairs. After 4 or 5 treatments most patients notice between a 50%-85% reduction in hair.

Both the long pulse diode and long pulse Nd:YAG lasers are the most appropriate lasers for laser-assisted hair removal in brown skin. One study reported a greater than 50% reduction of facial hair 6 months after treatment with a long-pulsed Nd:YAG laser. Laser therapy is relatively quick and takes anywhere from a few minutes to an hour, depending on the size of the area you are having treating. You will be able to immediately resume your normal activities after the treatment. It is important not wear make-up or apply skin care products before the procedure. All patients undergoing laser treatment should avoid becoming tanned both before and after hair removal treatments. In order for the treatments to be effective, you must have hair in the follicle for the laser light to target. Therefore, you should not wax, pluck, or shave 3- 4 weeks beforehand. The process itself is relatively painless and most patients report little to no pain. It is also important to protect your skin before and after the procedure with sunblock.

Treatment of Vascular Lesions (Blood Vessels)
As we age, women with lighter brown skin may develop red blood vessels (telangiectasias) on our faces and bodies as well as visible leg veins. Telangiectasias, leg veins and port wine stains (red birth marks) have all been treated with lasers. Using lasers for vascular lesions and vessels can be tricky because the types of light used to treat vascular lesions is also absorbed by the melanin in brown skin. This may lead to injury of the skin. Vascular lasers using longer wavelengths, such as the Nd:YAG laser, somewhat decreases this risk and are used to treat leg veins when sclerotherapy is not appropriate. With laser treatment, the laser light targets, penetrates, heats and damages the blood vessel. The body will then re-absorb the vessel, and the blood flow is re-directed through other veins. Treatments usually take 20 – 60 minutes and you may have a slight burning sensation.

In Asian skin, port wine stains have been treated with the flashlamp Pulse Dye Laser with variable results. In a study of 107 Asian patients, 23% had at least 50% clearing of the port wine stain but 14% had side effects the most common being abnormal skin pigmentation. The long pulse Nd:YAG laser has been used for the treatment of telangiectasias and small, red leg veins in women with brown skin. These laser treatments are usually well tolerated although abnormal skin pigmentation is a potential side effect.

Laser Removal of Tattoos
Although getting your tattoo was relatively easy, having it removed often takes a great deal of work. When a tattoo is made, ink is injected into your skin with needles and it becomes a permanent part of your skin. Lasers are commonly used to remove tattoos, but with variable success. Some ink colors are easier to remove than others. Because black pigment absorbs all laser light, it's the easiest to remove. Green is the most difficult color to remove, but red and blue are removed more easily. In general, having a tattoo removed can be both an expensive and time-consuming procedure.

The Q-switched Nd:YAG is probably the most appropriate laser for tattoo removal in people of color. Other lasers such as the Q-switched alexandrite and Q-switched ruby have been used, but there is a greater risk of light or dark marks and scarring developing in the skin. Tattoo removal may require up to 8-12 treatments with 6 to 8 weeks between treatments. The laser selectively targets the pigment of the tattoo, breaks down the tattoo pigment, and the body reabsorbs and excretes it. Each session will allow the laser to fragment more ink and penetrate further into your skin. Most tattoos are not removed completely with the laser treatment and a shadow of the tattoo may be visible after treatment.

Lasers for Pigmented Lesions
As discussed earlier, individuals with brown skin have higher levels of melanin in their skin, and melanin can be very reactive. Consequently, many skin disorders with unsightly increases in pigmentation can develop. These include melasma, postinflammatory hyperpigmentation, lentigines, and nevus of Ota. These disorders have been treated with lasers with variable success.

Melasma, which is particularly common in Asians, Latinas and African Americans has been treated with the Q-switched ruby and the erbium:YAG lasers, but unacceptable skin discolorations have often resulted. Lentigines (liver spots or sun spots), most common in Asians and Latinas, respond to the Q-switched ruby, Q-switched alexandrite, and the frequency-doubled Q-switched Nd:YAG lasers after one or two treatments. Initially, a white area on the skin appears and then scabs at the site of treatment. Postinflammatory hyperpigmentation may occur and has been reported in 1% to 50% of Asian patients treated with lasers.

Nevus of Ota (a dark patch located in the temple area) is very common in Asians, but also in African Americans. There are several lasers that have been used to treated Nevus of Ota including the Q-switched lasers, ruby, alexandrite, and 1064-nm Nd:YAG with variable results. Typically, it requires 3-4 treatments over 3-4 months to see improvement. Side effects include postinflammatory hyperpigmentation, hypopigmentation, rough areas on the skin and scarring. One investigator comparing the Q-switched alexandrite to the Q-switched Nd:YAG, in Asian skin for the treatment of nevus of Ota, found that the Q-switched alexandrite treatment was better tolerated, but the Q-switched Nd:YAG was more effective. In African Americans, the Q-switched Nd:YAG is the most appropriate for treating Nevus of Ota.

Keloidal and Hypertrophic Scars
First, it is important that your keloidal or hypertrophic scars not be treated with the carbon-dioxide laser, which is similar to surgical excision, because of the risk of the keloid growing back. Keloidal and hypertrophic scars have been treated with some degree of improvement with the pulse dye laser, which targets the blood vessels in the scar. This will decrease the blood supply and theoretically the keloid will shrink. The pulse dye laser does not totally remove the scar but reduces redness and the size of the scar. It leaves the scar softer and less itchy or painful. Sometimes the laser is combined with injections of steroids to flatten the scar more completely.

Intense Pulsed Light
Intense Pulsed Light (IPL) treatment, also called photorejuvination, is a new laser technology that can treat blood vessels, lentigines, fine lines and wrinkles, acne scars, and large pores. With IPL, high intensity pulses of broadband light are delivered to the skin. Since it is a non-ablative treatment, meaning it will not damage the surface of your skin, it is well suited for darker skin tones. The light goes deep into your skin and leaves the upper layers unharmed. The thermal action of IPL encourages the formation of collagen in the dermal layer of the skin, thus improving scars as well as the aged appearance of the skin.

Treatments take approximately 30-45 minutes and are usually repeated at monthly intervals. Generally, five treatments are required to reach your goals. During the facial treatment, most patients feel a slight discomfort characterized as a slight burning or stinging sensation. It is also important to avoid tanning before and after treatments, and cosmetics should not be worn on the day of the procedure. After the procedure, you will resume your normal activities including the use of make-up.

Bottom Line

In summary, the decision to have laser treatments is a very important one, and, as with all procedures, you should consider both the pros and cons. This is especially true for individuals with brown skin for whom there are more potential side effects than there are for Caucasians. It is important to select your laser doctor carefully. Always request a consultation during which you will want to discuss the doctor’s familiarity with not only the laser treatment, but also with brown skin. Make sure that you also discuss any problems with skin discolorations, keloidal or hypertrophic scarring, or medications that may effect the healing of your skin (steroids, isotretinoin). Finally, laser treatment is not magic, you must have realistic expectations....and it is not inexpensive either.

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