When talking about the use of lasers on the human body, one usually thinks of certain types of treatments related to aesthetic medicine, such as hair removal, rejuvenation, wrinkle removal, flaccidity improvement, body contour remodeling. However, the application of different types of light also exists in areas such as dermatology, ophthalmology, urology, phlebology.
Thus, it is used to treat scars of various types and origin, skin blemishes, onychomycosis (nail fungus), tattoo removal, therapy to treat melasma and rosacea, and even the early stage of urinary incontinence.
“For each entity we use a different type of laser (ablative – non-ablative) or a combination of them, with a particular wavelength, with different modes of emission (pure – pixelated), we also use intense pulsed lights”, he explains to NEWS the family doctor specializing in aesthetic medicine María Inés Reig, from Tierra del Fuego.
And he exemplifies: “If we want to treat rosacea, spider veins on the skin or deeper varicose veins, our target is the vessels, and for both superficial and deep vascular lesions, we use ND:YAG Laser and Intense Pulsed Light in its 540 and Dye version. On the other hand, if we want to restructure the skin after a scar caused by trauma or after surgery, we will use non-ablative lasers QS Switched 1064 nm pixelated, Erbium, CO2 ablative laser, or their combination (Alma Hybrid) to stimulate the fibroblast that it is our mason, the cell that generates collagen and elastin, necessary to repair the skin”.
Specialists may use a particular laser, or a combination of them, in addition to other therapies associated with the application of substances. A classic example of the latter occurs when a patient has scars.
“First you have to take into account what kind of severity they have, how deep they go, what kind of scars they are. Because even in the case of acne there are differences, they are not all the same -explains the dermatologist Irene Bermejo, with more than forty years of experience, both in public hospitals and in her clinic located in the Belgrano neighborhood-. There are patients who have little holes, as if a needle had been inserted into them. Others with scars that look flat, there are also those that seem to form a letter see and others, wavy. Not all are treated with the same technology and it will also be necessary to combine various technologies and complete with injectable substances, such as recombinant enzymes, hyaluronic acid, platelet-rich plasma, for example”.
This happens, Bermejo details, because the existing fibrosis at the base of the scar, what is not seen is, making an analogy, “like having carrots planted that pull down. So you want to smooth out the surface, but you also need to unravel that skein, that fibrosis, which is deep down”.
Scar
By combining technology with injected substances, you can work up and down, because by injecting enzymes, for example, it is feasible to dissolve that fibrosis by chemical means. “Other times you can resort to biostimulation, to break the fibrosis using a cannula.”
According to Bermejo’s experience, “in most cases acne scars remain imperceptible and it can even be achieved that they are not seen, for which it is necessary to have the possibility of combining technologies and treatments.” But there are also scars, as in the case of those that can be left after an accident, that can be very deep or very open, which look like there is a seam. “What we are going to try in those cases is to join the edges. So the ablative CO2 laser, which covered heat, is going to condense that little stretched skin that is in the middle. A microinjury is generated in the skin and that stimulates collagen. This can also be done with another laser, the Hybrid, because you are coagulating inside the collagen and trying to shrink, to retract the skin and bring the edges together as much as possible”, describes the specialist.
With the other scars with which keloids are made, “what you do with CO2 is lower that excrescence, that collagen that has grown excessively, without control, also combining with injectable substances. In summary, it is about using the physics of the laser with the chemical process of the injectable so as not to ask technology for everything just because they are extreme situations”, points out Bermejo, a member of the Argentine Society of Dermatology, the Argentine Medical Association and the American Academy Dermatology.
From his experience at the Aesthetic and Laser Medicine Clinic located in Río Grande, Reig describes: “The three types of scars, atrophic, hypertrophic and keloids, can be treated with laser technologies, regardless of their cause: surgical, trauma , acne, burns. Several clinical studies show that laser treatments, in addition to regenerating collagen, can also decrease blood flow values (which give the scar its reddish color) and relieve itching.”
If the scar, for example, is sunken, as in the case of a caesarean section, it has been cooked in deep layers (the uterus, the poneurosis, the fat, the muscle and the skin) when the stitches are removed, you have to start mobilizing that wound quickly, making traction on the wound transversally or longitudinally. Drainage and massage are also needed to release the fascia, banded networks of connective tissue that wrap around every internal part of the body from head to toe, because fascia also stick together. “In these cases, I need the CO2 laser for the surface, but also kinesiology to detach the fascia from the skin and debride that wound, and inject enzymes that detach the deep fibrosis”, summarizes Bermejo.
Goodbye tattoos. Removing tattoos is also possible with lasers, always under the action of an anesthetic cream so that the session is as pleasant as possible. The number of sessions, the type of technology to be used and the time they arrive, how big the tattoo in question is and how old it is.
“If it occupies an extended portion of skin, it divides it into four and we work on each sector, regularly and alternately. The more time you give the tattoo after each laser session, the better.
In four or five sessions on each area (in general, every 15 days), the tattoo can be perfectly removed”, describes Irene Bermejo.
But it must be taken into account that the tattoo does not contain white, not color, because sometimes tattoo artists make a gradient and to achieve that they put white dye, to go from red to pink, for example. And since white refracts light, it is not captured by the laser.
“The mechanical effect of the Q-Switched laser works by vibrating and breaking up the ink particles in the tattoo,” explains Reig. As soon as the treatment area begins the healing process, the immune system eliminates the fragmented ink particles causing the tattoo to disappear, minimizing the risks of scarring or hypopigmentation. The tattoo loses color session by session, until it disappears completely.
There are no particular contraindications in tattoos “but those common to laser treatment, such as being undergoing an oncological disease, pregnancy, lactation,” adds Reig, also a graduate in gynecology.
Bermejo points out: “Sometimes, when the tattoo is multicolored, it is necessary to resort to the pico-second laser (a billionth of a second), which, due to its extremely short and faster pulse, pulverizes anything, the Alma laser in particular. His pulse is so extremely short that it acts as a kind of bombardment on the skin, pulverizing the tattoo, leaving it in pieces so small that they can be removed or are not visible to the naked eye. If the treatment is well done, the effect is excellent and the skin is not damaged”.
pigmented lesions
Melasma is an acquired pigmentation that does not represent a health risk but does cause social discomfort for those who have it, because it occupies the center of the face. “The non-ablative QSwitched 1064 nm pixelated laser delivers large concentrations of energy with short pulses, which allows for more effective treatments, with greater depth, and with minimal risk of post-inflammatory pigmentation and damage to surrounding tissue”, indicates Reig. In this case, it does not matter how deep the pigment is.
In the case of rosacea, an inflammatory dermatosis, “it is something much more delicate, what we try to do is bring out the color, try to close the vessels. We want that face that is red to whiten and there we will apply beams or intense pulsed light to treat the vascular system”, says Bermejo. Topical anti-inflammatories and (where appropriate) antibiotics for local application or oral intake are also applied.
Onychomycosis is also treatable from lasers. By thermal and mechanical effect, the technology creates a series of shock waves that manage to break the hard outer layer of the fungus spore, until the microorganism is destroyed through a thermal effect.
Finally, there is a laser that can be used intravaginally and is used for vulvar rejuvenation but also in stress urinary incontinence. In these cases there are small urine losses when the woman jumps while exercising or even when she laughs. “The laser causes pixelated micro-damage and, before that, the body will repair it by generating collagen,” Reig details. The whole process generates tension in the tissues and these urine losses no longer occur. In the case of dyspareunia (lack of lubrication during sexual intercourse) the laser causes a construction of collagen, the production of new cells with hyaluronic acid and increases lubrication naturally”.
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