Getting Good Results

High-quality results are attributable much more to the surgeon than to the laser. Although any physician who follows a rote cookbook approach to laser surgery can achieve results, outstanding results require significant skill on the part of the surgeon. Top-quality laser surgeons usually develop their own techniques. Surgeons who perform many laser procedures constantly refine their technique and are able to achieve substantial improvement for the patient while avoiding the risks associated...

What Are Lasers and How Do They Work

For a better understanding of the special advantages of lasers in cosmetic surgery, we need to know what a laser is. How is laser energy produced What are the properties of laser light that distinguish it from conventional light or other energy sources Why are lasers uniquely suited to treat special skin problems of cosmetic concern to patients Is a laser really that special, and why The story of lasers begins over a hundred years ago. A laser is an instrument that produces a special type of...

Scars

A scar is a permanent alteration in the skin's texture. Hypertrophic scars are thicker than the surrounding skin atrophic scars are thinner (depressed). A scar is usually the result of an injury. Scars are an alteration of the connective tissue of the dermis. An injury that heals with the production of too much dermal collagen may result in a hypertrophic scar. If too little collagen is produced with healing, an atrophic scar may result. The most common facial scars are caused by acne or...

Laser Treatment of Tattoos

Black is the most responsive tattoo ink and responds equally well to all three Q-switched lasers. Black ink particles absorb all visible wavelengths. Red ink requires treatment with the frequency-doubled (532 nm) Q-switched Nd YAG laser. Green responds to Q-switched ruby (694 nm) and alexandrite (755 nm) lasers and can also be treated with the Q-switched Nd YAG laser using a special handpiece that alters the wavelength of the laser energy to 650 nm. Dark blue ink may respond as black ink does....

Laser Resurfacing with the CO2 Laser

Cold Sore Crusting Stage

I reserve the CO2 laser for full-face resurfacing. The goal of full-face resurfacing is to obtain maximum improvement of photo-aged skin. Many patients who consider full-face laser resurfacing are also considering a facelift. These patients are interested in significant improvement and realize that real changes are possible with a serious investment in cosmetic surgery. In patients whose skin has suffered extensive sun damage, full-face laser resurfacing may provide more impressive rejuvenation...

Procedures Done in Advance of Laser Resurfacing

There are several procedures, both surgical and nonsurgical, that complement laser resurfacing. Most of these complementary procedures can be performed either before or after the resurfacing, but I generally prefer to do them prior to resurfacing. For patients with extensive sun damage, full-face resurfacing with the CO2 laser is perhaps the single cosmetic surgery that can result in the greatest overall facial rejuvenation (see chapter 6 and figs. 6.3 and 6.4). The tightening of facial skin...

Laser Hair Removal

Hair removal lasers all target melanin. Unwanted hairs tend to be relatively large and dark. There is a much higher concentration of melanin in the hair follicle than in the surrounding skin this difference provides selectivity so that the laser's effect is much greater on the hair follicle than elsewhere. Human hair varies widely in diameter and color as well as in growth characteristics the response to laser hair removal treatment is affected by all of these physical features. Because of the...

Removing Vascular Skin Lesions

In younger patients, port wine stains are usually composed of superficial capillaries, whereas in adults they may also include larger, darker blood vessels. Lesions that are composed primarily of capillaries respond best to pulsed dye laser treatment those with larger vessels may also require treatment with a continuous-wave laser, such as the krypton, argon, or normal mode Nd YAG lasers. Pulsed dye laser therapy is moderately painful. The painful sensation is felt briefly during each laser...

Laser Resurfacing with the ErbiumYAG Laser

Because erbium YAG laser energy is almost completely consumed by vaporization of skin cells, resurfacing with this laser is substantially less painful than with the CO2 laser. Although erbium YAG resurfacing is not painless, the majority of facial areas can be treated using only topically applied anesthetic. Several effective anesthetic creams are available. Most provide better anesthesia if applied for longer periods prior to erbium YAG laser resurfacing. One topical anesthetic, EMLA cream,...