Laser Resurfacing
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Photorejuvenation is a skin treatment that uses
laser A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word ''laser'' originated as an acronym for light amplification by stimulated emission of radi ...
s,
intense pulsed light Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation (e.g. the treatment of skin pigmentation, ...
, or
photodynamic therapy Photodynamic therapy (PDT) is a form of phototherapy involving light and a photosensitizing chemical substance used in conjunction with molecular oxygen to elicit cell death ( phototoxicity). PDT is used in treating acne, wet age-related macula ...
to treat
skin condition A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...
s and remove effects of
photoaging Photoaging or photoageing (also known as "dermatoheliosis") is a term used for the characteristic changes to skin induced by chronic Ultraviolet, UVA and UVB exposure. Effects of UV light Molecular and genetic changes UVB rays are a primary ...
such as wrinkles, spots, and textures. The process induces controlled
wound A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma (mechanical, thermal, chemical), or can develop slowly over time due to underlying diseas ...
s to the skin. This prompts the skin to heal itself, by creating new cells. This process—to a certain extent—removes the signs of photoaging. The technique was invented by Thomas L Roberts, III using lasers in the 1990s. Observed complications have included
scar A scar (or scar tissue) is an area of fibrosis, fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other Organ (anatomy), organs, and biological tissue, t ...
ring,
hyperpigmentation Hyperpigmentation, also known as the dark spots or circles on the skin, is the darkening of an area of Human skin, skin or nail (anatomy), nails caused by increased melanin. Causes Hyperpigmentation can be caused by sun damage, inflammation, or ...
,
acne Acne ( ), also known as ''acne vulgaris'', is a long-term Cutaneous condition, skin condition that occurs when Keratinocyte, dead skin cells and Sebum, oil from the skin clog hair follicles. Typical features of the condition include comedo, ...
, and
herpes Herpes simplex, often known simply as herpes, is a viral infection caused by the herpes simplex virus. Herpes infections are categorized by the area of the body that is infected. The two major types of herpes are oral herpes and genital herp ...
.


Skin rejuvenation

Skin rejuvenation can be effected through various modalities, including thermal, chemical, mechanical, injection, and light.


Laser resurfacing

Laser resurfacing is a
laser surgery Laser surgery is a type of surgery that cuts tissue using a laser in contrast to using a scalpel. Soft-tissue laser surgery is used in a variety of applications in humans ( general surgery, neurosurgery, ENT, dentistry, orthodontics, and ...
technique that disassociates molecular bonds. It is used for the treatment of wrinkles, solar lentigenes, sun damage,
scar A scar (or scar tissue) is an area of fibrosis, fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other Organ (anatomy), organs, and biological tissue, t ...
ring (
acne scars Acne ( ), also known as ''acne vulgaris'', is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, ...
and surgical scars),
stretch marks Stretch marks, also known as striae () or striae distensae, are a form of scarring on the skin with an off-color hue. Over time, they may diminish, but will not disappear completely. Striae are caused by tearing of the dermis during periods of ...
,
actinic keratosis Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a Premalignant condition, pre-cancerous area of thick, scaly, or crusty skin.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed. ...
, and
telangiectasia Telangiectasias (), also known as spider veins, are small dilated blood vessels that can occur near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. These dilated blood vessels can develop anywhere ...
s. It can be combined with
liposuction Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, lip ...
to help tighten and smooth over the new contours after removal of excess fat. Resurfacing can be ablative, which vaporizes tissue and creates wounds, or non-ablative which keeps the skin intact. Laser resurfacing is usually done with a 2940 nm Er:YAG laser or a 10,600 nm laser. Complete resurfacing was first done with a laser. Both erbium and are used to treat deep
rhytide A wrinkle, also known as a rhytid, is a fold, ridge or crease in an otherwise smooth surface, such as on skin or fabric. Skin wrinkles typically appear as a result of ageing processes such as glycation, habitual sleeping positions, loss of bo ...
s, sun damage and
age spots Liver spots (also known as age spot, solar lentigo, "lentigo senilis", "old age spot", "senile freckle") are blemishes on the skin associated with aging and exposure to ultraviolet radiation from the sun. They range in color from light brown to re ...
. Through the heating of the deep
dermis The dermis or corium is a layer of skin between the epidermis (skin), epidermis (with which it makes up the cutis (anatomy), cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from s ...
,
fibroblasts A fibroblast is a type of biological cell typically with a spindle shape that synthesizes the extracellular matrix and collagen, produces the structural framework ( stroma) for animal tissues, and plays a critical role in wound healing. Fibrobla ...
are stimulated to form new
collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...
and
elastin Elastin is a protein encoded by the ''ELN'' gene in humans and several other animals. Elastin is a key component in the extracellular matrix of gnathostomes (jawed vertebrates). It is highly Elasticity (physics), elastic and present in connective ...
helping to bring increased turgor and thickness to the skin. A variety of modes have been developed including Nd:Yag lasers and a plasma device. resurfacing has been shown to have an increased risk of
hypopigmentation Hypopigmentation is characterized specifically as an area of Human skin, skin becoming lighter than the baseline skin color, but not completely devoid of skin pigment, pigment. This is not to be confused with depigmentation, which is characterize ...
and scarring than erbium lasers. This is due to the high degree of coagulation and thus heat production that occurs as a nature of the wavelength.


Fractional laser

Fractional laser
photothermolysis Laser hair removal is the process of hair removal by means of exposure to pulses of laser light that destroy the hair follicle. It had been performed experimentally for about twenty years before becoming commercially available in 1995–1996. One ...
(FP) is a form of laser-based skin resurfacing, with several devices on the market, such as
Fraxel Fraxel Laser Treatment is a line of lasers developed by Reliant Technologies in 2004. It was developed from a US patent licensed from the Wellman Center for Photomedicine. R. Rox Anderson was the inventor. Fraxel lasers cause fractional photothe ...
. A fractional laser delivers laser light to the skin. Hundreds or thousands of laser pinpoints may be used per square inch, leaving healthy skin between the ablated areas. Complications observed in a study of 961 treatments included
acne Acne ( ), also known as ''acne vulgaris'', is a long-term Cutaneous condition, skin condition that occurs when Keratinocyte, dead skin cells and Sebum, oil from the skin clog hair follicles. Typical features of the condition include comedo, ...
and
herpes Herpes simplex, often known simply as herpes, is a viral infection caused by the herpes simplex virus. Herpes infections are categorized by the area of the body that is infected. The two major types of herpes are oral herpes and genital herp ...
outbreaks. There have been anecdotal negative accounts of bad scarring and
hyperpigmentation Hyperpigmentation, also known as the dark spots or circles on the skin, is the darkening of an area of Human skin, skin or nail (anatomy), nails caused by increased melanin. Causes Hyperpigmentation can be caused by sun damage, inflammation, or ...
. Erbium and fractional systems have a better safety profile than lasers of the past.


Intense pulsed light

Intense Pulsed Light Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation (e.g. the treatment of skin pigmentation, ...
(IPL) uses flashlamps (and not lasers) to produce high intensity light over broad visible and infrared wavelengths with filters that select the desired range. IPL is used to treat dyschromia, rosacea, melasma, acne, photodamage, vascular and pigmented lesions, and rhytides. One study conducted by a group of four researchers from the
Weill Cornell Medical College of Cornell University Weill Cornell Medicine (; officially Joan and Sanford I. Weill Medical College of Cornell University), originally Cornell University Medical College, is the medical school of Cornell University, located on the Upper East Side of Manhattan in N ...
in 2004 found IPL to be a "non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events". Other studies, however, have noted that exposing cells to direct heat can cause
DNA Deoxyribonucleic acid (; DNA) is a polymer composed of two polynucleotide chains that coil around each other to form a double helix. The polymer carries genetic instructions for the development, functioning, growth and reproduction of al ...
damage—not only in those cells, but also in surrounding tissue that was not directly exposed, and concluded treatments can cause microscopic thermal injuries, and that further research is warranted. IPL is effective for pigmentation and telangiectasias, but has lesser results for wrinkles.


Photodynamic therapy

Photodynamic therapy Photodynamic therapy (PDT) is a form of phototherapy involving light and a photosensitizing chemical substance used in conjunction with molecular oxygen to elicit cell death ( phototoxicity). PDT is used in treating acne, wet age-related macula ...
(PDT) uses photosensitive compounds that are activated by light. It is used to treat actinic keratoses, acne, photoaging, and skin cancer.


See also

*
Laser surgery Laser surgery is a type of surgery that cuts tissue using a laser in contrast to using a scalpel. Soft-tissue laser surgery is used in a variety of applications in humans ( general surgery, neurosurgery, ENT, dentistry, orthodontics, and ...


References

{{Lasers Laser medicine Dermatologic surgery