Laser Based Treatments
Laser Resurfacing
The surface layers of the skin are removed in order to erase or soften wrinkles, sun damage, and scarring or pigmentation problems.
Resurfacing has been performed by chemical peels and dermabrasion but these techniques have largely given way to lasers.
How does laser resurfacing work?
Resurfacing lasers create a controlled burn to 'peel' back the skin to a level less affected by scarring or sun damage. C02 and Erbium lasers can be used to resurface a range of skin conditions but have individual advantages in certain circumstances.
The C02 laser removes a deeper layer of skin in one pass than the Erbium, and also provides more thermal damage to the underlying structures. This is of benefit to patients who have scarring or severely sun-damaged skin, as a degree of 'tightening-up' in the skin is also achieved. C02 laser resurfacing is almost always performed under general anaesthetic in a hospital setting.
The Erbium laser removes a very fine layer of skin at a time and produces minimal thermal damage to the surrounding tissues. This translates to less post-operative redness, and a shorter healing time. It is very suitable for moderate degrees of sun-damage and more suitable for darker-skinned patients than the C02. Erbium is often performed in our rooms, and may only require a local anaesthetic cream, although if broad areas are to be resurfaced, a hospital setting may be advised.
For what conditions is laser resurfacing ideal?
- General signs of sun-damage such as thicker, leathery skin, age spots and blotchy pigmentation.
- Rhinophyma (strawberry nose) can be de-bulked and reshaped with the C02 laser.
- Laser resurfacing constitutes a great advance in the treatment of acne scarring. Resurfacing with the laser softens the scarring, but is often combined with other treatments such as dermal grafting or fat transplants for the best overall result. Erbium laser (but not C02 laser) may be employed on areas other than the face, such as the neck chest, hands, etc.
Areas treated
The full face may be resurfaced or smaller areas such as the upper lip, or under eye region. Resurfacing removes fine wrinkling and will soften, but not completely erase stronger lines such as deep smile lines, crow's feet and forehead lines. (If these expression lines are the only concern, an injectable filler or muscle relaxant may be a better treatment option.)
The procedure
Local anaesthetic or an anaesthetic cream will be applied to the area prior to the procedure. (C02 laser is normally performed under general anaesthetic.) Protective eyewear is worn during the laser use. The area is resurfaced and icepacks are applied. It is normal to feel a burning sensation (like sunburn) for 10-90 minutes following the procedure. Dressings or bandages may be used to cover the area.
The healing process
The procedure produces a burn that must heal. Any areas not covered by dressing will be covered with a greasy ointment for several days. It is important that the areas remain moist until healing is complete (usually one week.) The area will ooze, and there may be swelling. When healed, the skin will look pink and this gradually fades over 2-12 weeks. Redness normally fades more quickly after Erbium than C02.
Laser and Non-Laser Hair Removal
Long-term hair removal can be achieved with a minimum of discomfort or inconvenience with our long pulse Alexandrite (Elite) hair-removing laser.
How is hair removed by laser?
The laser emits a powerful beam of light that passes harmlessly through the skin, but is absorbed by the hair follicle. By selectively absorbing the laser energy, the hair follicles are disabled, impairing their ability to grow hair.
This is a safer, faster and more effective way to eliminate unwanted hair than traditional methods of depilation. Laser hair removal is most effective when the hair colour is significantly darker than the skin, e.g. dark hair on fair-skinned individuals, or black hair on darker skin colours.
What other methods are available to remove hair?
Epilation is another effective technique when undertaken by a professional. It incorporates fine wire diathermy, which is a treatment that works by passing a small electric charge down a hair-like needle into an unwanted spot, causing the spot to shrivel and disappear. It does so over the following few days to weeks depending on the body part treated and the amount of current used. In this procedure, insulated needles are passed down the hair follicle to the hair bulb. These insulated needles only expose the tip of the needle; the rest is coated in a sleeve that does not conduct electricity. Thus they do not injure the surrounding skin in the process of destroying the hair bulb.
Modern fine wire diathermy should not be confused with the rather gross diathermy delivery systems of the past. Correctly used, this is a most elegant technique and one that gives uniformly good results.
Over the years, various other methods have been used to remove unwanted hair such as shaving, waxing, plucking and depilatory creams. These methods only remove hair temporarily and some may be painful or cause inflammation of the hair follicle. Electrolysis offers more long-term hair removal, but takes months or years of treatment and innumerable sessions since it requires the placement of a needle at each hair follicle. This process is tedious, and impractical for large areas.
The advantages of laser hair removal
- Fewer treatments required;
- suitable for large areas;
- more accurate (unlike electrolysis, laser light can't 'miss' the follicle);
- non-invasive (no risk of needle-transmitted disease).
Laser treatment provides long-term hair removal for large or small areas, without the difficulties or commitment involved with other methods. The laser is designed to selectively treat only the hair follicle, leaving the surrounding tissue unaffected. The laser uses pulses of light to remove the hair, so there is little irritation to the skin.
Is the laser treatment comfortable?
The treatment consists of a number of laser pulses accompanied by a tingling or slight burning sensation. Anaesthetic cream is applied to the area 30 minutes prior to treatment to ensure this sensation is minimal. Within about 30 minutes of treatment, the areas may become pink or red, and feel like mild sunburn for a day or so. Because the laser does not damage the skin, no bandages are necessary.
How long does it take?
Each laser pulse treats about a half-inch area, which can contain ten or more hairs. The amount of time needed depends on the size of the area to be treated. The lip usually takes less than one minute; other areas such as the leg may take significantly longer.
How many treatments will be necessary?
The laser works by affecting the hair follicles, which are in the growing (anagen) phase. At any time, some hair follicles are in the resting (telogen) phase and won't be treated by the laser. Therefore several visits may be necessary for total treatment. We now know that the hair removal lasts at least 18 months.
About the treatment
The treatment is only available to those with sufficiently dark hair - blonde, red and grey hair do not respond well. A consultation with one of our specialist nurses is required to determine your suitability for the treatment. Information about the time involved to treat various areas of the body can be given to you at this time and an appointment made for your test patch. Do not wax or pluck the area to be treated for one month prior to laser hair removal. The area should be shaved three days prior to laser hair removal.
Hypertrophic and Keloid Scar Treatments
These scars are the result of the body's over-zealous attempt to heal and replace lost or damaged skin. The means of correcting such as a scar depends upon its specific characteristics.
Not all scars are alike. In fact, there is a wide range of different scar-types, some of which protrude above the skin. One such scar is the keloid scar: an overgrowth of fibrous tissue/collagen that the body produces in response to an injury. These scars may appear anywhere on the body. Keloid scars extend beyond the borders of the original wound and they do not regress spontaneously.
The cause of keloid scars is unknown, but they appear more frequently in darker-skinned people. They tend to occur primarily in people aged between 10 and 30 years of age.
Treatments
The treatment of keloid scars is complex. All scars are permanent and there is no single technique to remove them completely. However, with treatment, the keloid scars may become smaller, softer, less tender and less red in colour. Attempts to surgically remove keloids are fraught with danger as they tend to reform and become bigger than before. As no single therapeutic method has been demonstrated for all keloid scars, the type of therapy used will depend on several factors, some of which relate to the scar's characteristics (location, size, colour, etc.), and others to the patient herself (the person's age, and past response to treatment).
Several treatment modalities are available to treat these scars. These include:
- intralesional cortisone or injections of other agents such as fluorouracil (5FU) or bleomycin;
- laser therapy;
- cryotherapy (liquid nitrogen);
- topical creams and dressings.
Laser-Assisted Punch Grafting
Scarred areas of the face are released or replaced with healthy skin from another site.
The best scars to treat by punch grafting are small (less than 3-4mm) deep, and sharp-walled, e.g. the ice-pick scars of acne of chicken pox. This procedure gives a permanent correction if the graft survives in its new location.
The procedure
Under local anaesthetic, the scar is removed with a punch biopsy. This instrument cuts out the scar, leaving a small circular wound. This is then filled with a piece of skin taken from another area [usually behind the ear]. The recipient site usually has a dressing, while the donor site will have some stitches.
Any number up to about 25 grafts may be placed at one time. If more grafts are required, this is usually best divided into two procedures. One to two months later, a resurfacing laser procedure may be necessary to merge the grafts into the surrounding skin.
The healing process
After one week, dressings and stitches are removed. The little grafts look like small bumps on the face until the area is lasered 1-2 months later, and will require some make-up for several months until the merging process with the surrounding skin is complete. During this phase, the grafts may look different in colour (usually pinker), and the edges may be visible. These aspects settle during the healing process.
Laser Blepharoplasty
The surgical correction of excess fullness or bagginess of the upper eyelid, or of 'bags' beneath the eye
As we age, the delicate skin of the eyelid loses its elasticity and may hang down in a fold, giving a hooded look to the eyes. In the most extreme cases, the sagging skin rests on the eyelashes and partially obscures peripheral vision. In the lower eyelid, the pocket of fat that normally sits behind the eye protrudes forward through a weakened septum, causing the "bags" under the eyes. This is commonly an inherited tendency and may cause an appearance of perpetual tiredness. The upper and lower eyelids may be affected separately or together, but the lower lids are frequently worse.
The procedure
Upper Eyelids
An incision is made in the natural crease of the upper eyelid. Excess skin and protruding fat are removed, and the skin edges are closed with fine, dissolving stitches. A very fine scar results, which fades with time and is hidden in the eyelid crease.
Lower Eyelids
The technique for the lower eyelids is different for scalpel and laser. The scalpel method involves an incision along the lower eyelid margin, then excess skin and fat are removed, and the skin edges are closed with fine stitches. This sometimes drags down the lower eyelid and produces an unusual appearance. Laser blepharoplasty of the lower eyelid has the advantage of having no skin incisions or stitches. Excess fat is removed through the inside surface of the lower eyelid. Wrinkles or crow's feet beneath the eye may be removed very effectively by resurfacing this area with the laser. The deepest expression lines at the sides of the eyes may be softened but not totally removed by this method.
Blepharoplasty procedures are performed in a day surgery or small hospital under a light general anaesthetic. You may go home following the procedure accompanied by a friend, but you are often advised to stay overnight in hospital. You should not drive on the day of the surgery.
The use of lasers for eyelid surgery
A laser is a very powerful light beam that is able to be used as a precise cutting tool or to remove fine layers of tissue. Used in blepharoplasty procedures, its advantages over the scalpel technique are that:
- it leaves no visible scar on the lower eyelid;
- no ectropion (dragging down of the eyelid) occurs, which is common with other methods;
- there is virtually no bleeding with the laser, and therefore minimal bruising or swelling;
- a shorter recovery time is required, allowing for an early return to work and social commitments.
The healing process
Normal activities may usually be recommenced two-three days following the lower eyelid procedure and eye make-up may be worn after this time. Stitches in the upper eyelid either dissolve or are removed by 7 days, and one or two weeks off work may be required.
Vascular and Pigmentation Lasers
Red blood vessels, flushing and brown age and sun spots are now able to be erased with the Gemini and VBeam lasers.
What conditions can be treated with vascular laser?
Facial blood vessels and birthmarks such as port wine stains and strawberry haemangioma are commonly treated with laser, as are brown sun spots and age spots. Freckles are also treatable with laser. Blood vessels on the legs are usually treated more successfully with sclerotherapy injections than with laser. Moles are not lasered.
Another condition that is often treated with this laser is poikiloderma of Civatte: a condition involving the mottling of the skin (usually the neck and décolletage) due to the proliferation of blood vessels. The skin appears both brown from the mottling and ruddy from the visible blood vessels. The onset of this condition is best prevented by avoiding exposure to the sun. Other treatments may be used as alternatives to laser therapy, or as adjunct treatments. These include bleaching creams and vitamin K-based creams.
Laser systems
Early medical lasers varied considerably, however rapid advances in laser technology mean today's machines are safe, faster and vastly more effective.
The procedure
A local anaesthetic is applied thickly to the area 30-40 minutes prior to treatment and covered with cling wrap. This numbs the area. Safety glasses will be used during the procedure. The initial treatment session may be devoted to testing the skin and assessing it's response to different laser settings.
A number of treatments may be required to fade blood vessels and birthmarks and treatments are usually spaced four weeks apart. Some birthmarks may fade but not be completely erased by the laser.
Brown marks and freckles usually require just one treatment. The darker they are, the more successful the treatment.
What to expect following treatment
The treated area is often swollen for several days following treatment. Some scabbingand even blistering may be seen.
The healing process
Ice packs should be applied to the areas for the first 48 hours, and antiseptic cream may be applied twice daily. Vigorous cleansing or rubbing of the area should be avoided if scabs have formed. Scabs usually last around a week; however it is permissible to wear make-up and an SPF 30+ sunscreen. It is important to avoid sunlight or solariums in the healing phase.
Clearlight 100
In this procedure, a selective light beam safely and accurately penetrates the skin and destroys precancerous tissue and acne bacteria without causing harm to tissues.
Acne usually starts in adolescence when hormonal changes cause the enlargement and then the obstruction of sebaceous glands in the skin. The obstruction of the glands' openings causes the accumulation of oil which is followed by abnormal proliferation of bacterial population predominantly Propionibacterium acnes (p.acnes).
P. acnes attract inflammatory cells and hence the unsightly, red, painful pustules of acne are formed.
How does the ClearLight 100™ work?
ClearLight 100™ uses Acne Selective Photo Clearing (SPC™) technology with the optimal 405-420nm narrow band violet/blue light to destroy Propionibacterium acnes (p .acnes) within the skin, quickly and easily.
The selective light of ClearLight 100™ safely and accurately penetrates the skin and destroys acne bacteria without causing harm to tissues.
We usually use this in conjunction with a stimulating chemical (ALA) that magnifies the effect on the bacteria and sebaceous glands and allows a very high incidence of clearing.
The healing process
This procedure does not involve any surgical incision as such, so there is no down-time. However, flaky skin is shed as the damaged areas heal.
Patients must avoid exposure to sunlight for 48 hours following the procedure. This will enable the procedure to be fully effective.
An intense but gentle burst of light that selectively destroys the blood vessels of your spider veins, without damaging the surrounding tissue.
After laser treatment the surrounding tissue is left intact and normal pigmentation occurs.
For vascular lesions, such as port wine stain birthmarks, stretch marks, scars, facial spider veins or warts, some patients have tried surgery, electrocautery, cryotherapy (freezing the area). These procedures often may result in scarring or may leave an unsatisfactory result.
Other lasers are not as specific in the destruction of the blood vessels in the vascular lesions. Our other vascular lasers, the Orion® and the Gemini® still are excellent machines, but we are adding to the versatility of the clinic with the VBeam®.
As for treating birthmarks and certain vascular conditions, the VBeam® system is easily the most sophisticated and most powerful of laser machines available.
Treatment with the VBeam® may consist of multiple treatments. For facial veins, one treatment may be sufficient for clearance but a second visit is recommended for optimal results. These treatments occur on an average of once every six to twelve weeks.
Laser Tattoo Removal
The Medlite Laser removes tattoo ink using the energy of light. This laser is effective for both amateur and professional tattoos. It is at its best for black and red tattoos but special laser handpieces mean that many other tattoo colours may treated but are more difficult. Essentially, energy is absorbed by pigment found in the tattoo. The melanin is fragmented so small that is can be easily removed without injury to normal tissue. This treatment is safe and convenient with little downtime or rosk of side effects.