LASER DERMATOLOGY 101

In recent years, the field of dermatology has witnessed remarkable advancements in utilizing various types of lasers to enhance skin health and achieve laser skin resurfacing (LSR) [1]. These innovative technologies offer non-invasive solutions for skin protection, repair, and rejuvenation, addressing a wide range of concerns from acne scars and hyperpigmentation to wrinkles and skin barrier repair. Backed by published research, this article explores how different types of laser technology are being harnessed to achieve remarkable results in dermatological treatments.

FRACTIONAL LASER TECHNOLOGY

Most commonly employed with C02 or erbium:YAG lasers, fractional laser technology is used to deliver controlled, fractional damage to the skin's surface and/or dermal skin layers that leads to barrier repair [2]. Fractional lasertherapy can be both “ablative” (removes cells at the skin’s surface) or “non-ablative” (stimulates damage and repair below the surface). This process stimulates the skin's natural healing response, promoting collagen production and minimizing the appearance of fine lines, wrinkles, and sun damage. Research has shown that fractional laser therapy can effectively enhance the skin's protective barrier, reducing water loss, improving overall skin texture, and increasing the uptake of topicals [3,4]. Common examples of the non-ablative type would be the Fraxel laser (CO2), the Moxi laser, and the Laser Genesis (Nd:YAG) protocol.

Q-SWITCHED LASER TECHNOLOGY

Typically a technique that is used with Nd:YAG lasers, Q-switch lasers produce extremely short pulses of high-energy light that target specific pigments, such as those found in tattoos, age spots, and melasma. The Nd:YAG laser is the preferred laser for tattoo and hair removal, especially on darker skin tones [5]. Recent advances have led to the development of the picosecond lasers (e.g. PicoWay) which are more costly but can be less painful [6]. Clinical trials have demonstrated the efficacy of Q-switched lasers in breaking down pigmented lesions and acne scarring while leaving surrounding skin unharmed [7,8].

CO2 LASERS

Carbon dioxide lasers have been widely used for skin resurfacing and scar revision. CO2 lasers can be used in both ablative (surgical for many types of dermatological abnormalities) or non-ablative contexts (aesthetic treatments for hyperpigmentation and wrinkling) [7,9]. As described above, whether or not the laser is used fractionally determines its depth, strength, and overall effects. CO2 lasers are not usually employed for tattoo or hair removal due to the more superior Nd:YAG mentioned above [10]. 

Er:YAG LASERS

Erbium (Er) lasers operate at a wavelength that is highly absorbed by water, making them effective for precise and shallow skin ablation [11]. This is the most common laser for aesthetic skin resurfacing to treat photoaging and acne scarring. Once again, Er:YAG lasers can be used for both ablative and non-ablative treatments and have shown to be even more effective in combination with other rejuvenation procedures like platelet-rich plasma [12].

PULSED DYE LASERS

Known for their ability to target blood vessels and reduce redness, pulsed dye lasers (PDLs) or intense pulsed light (IPL) therapy are effective in treating conditions like rosacea and vascular birthmarks. Further research has also shown the PDLs are effective in treating active acne and other dermatological conditions [13]. 

CONCLUSION

The use of laser therapies in dermatology is widespread, non-invasive, and generally very successful. Combinations of multiple laser modalities or additional agents like light therapy or topical adjuvants can also enhance results. The scientific research supporting the efficacy of various laser technologies for skin protection, repair, and rejuvenation is relatively substantial compared to many other interventions and continues to evolve. In addition to laser therapies, Broadband Light (BBL) therapy and Ultherapy (ultrasound-based) are also used for treating photoaged skin, while Morpheus8 (microneedling combined with radiofrequency) is used for treating skin laxity, discoloration, and acne scarring. However, it's essential to note that laser treatments should always be administered by trained professionals and tailored to individual skin types and concerns for optimal results and safety.

SOURCES: 

[1] Alexiades-Armenakas MR, Dover JS, Arndt KA (2012) Fractional laser skin resurfacing.J Drugs Dermatol 11, 1274–1287.

[2] Carniol PJ, Hamilton MM, Carniol ET (2015) Current Status of Fractional Laser Resurfacing.JAMA Facial Plast Surg 17, 360–366.

[3] Wang JV, Friedman PM, Agron S, Konda A, Parker C, Geronemus RG (2022) Quantifying Skin Uptake of Topicals After 1,927-nm and 1,440-nm Nonablative Fractional Diode Laser Treatment.Dermatol Surg 48, 822–826.

[4] Cao Y, Wang P, Zhang G, Hu C, Zhang H, Wang X (2021) Administration of skin care regimens containing β-glucan for skin recovery after fractional laser therapy: A split-face, double-blinded, vehicle-controlled study.J Cosmet Dermatol 20, 1756–1762.

[5] Vaidya T, Hohman MH, Kumar D D (2023) Laser Hair Removal. InStatPearls StatPearls Publishing, Treasure Island (FL).

[6] Ho SG, Goh CL (2015) Laser Tattoo Removal: A Clinical Update.J Cutan Aesthet Surg 8, 9–15.

[7] Vachiramon V, Panmanee W, Techapichetvanich T, Chanprapaph K (2016) Comparison of Q-switched Nd: YAG laser and fractional carbon dioxide laser for the treatment of solar lentigines in Asians.Lasers Surg Med 48, 354–359.

[8] Sabry HH, Hegazy MS, Ahmed E, Salem RM (2022) Q-Switched 1064-nm Nd: YAG laser versus fractional carbon dioxide laser for post acne scarring: A split-face comparative study.Photodermatology, Photoimmunology & Photomedicine 38, 465–470.

[9] Conforti C, Vezzoni R, Giuffrida R, Fai A, Fadda S, Marangi GF, Persichetti P, Piccolo D, Segreto F, Zalaudek I, Dianzani C (2021) An overview on the role of CO2 laser in general dermatology.Dermatologic Therapy 34, e14692.

[10] Krupa Shankar D, Chakravarthi M, Shilpakar R (2009) Carbon Dioxide Laser Guidelines.J Cutan Aesthet Surg 2, 72–80.

[11] Modena DAO, Miranda ACG, Grecco C, Liebano RE, Cordeiro RCT, Guidi RM (2020) Efficacy, safety, and guidelines of application of the fractional ablative laser erbium YAG 2940 nm and non-ablative laser erbium glass in rejuvenation, skin spots, and acne in different skin phototypes: a systematic review.Lasers Med Sci 35, 1877–1888.

[12] El-Taieb MA, Ibrahim HM, Hegazy EM, Ibrahim AK, Gamal AM, Nada EA (2019) Fractional Erbium-YAG Laser and Platelet-Rich Plasma as Single or Combined Treatment for Atrophic Acne Scars: A Randomized Clinical Trial.Dermatol Ther (Heidelb) 9, 707–717.

[13] Forbat E, Al-Niaimi F (2019) Nonvascular uses of pulsed dye laser in clinical dermatology.Journal of Cosmetic Dermatology 18, 1186–1201.