Indications to laser treatments

Contraindications to laser treatments:

• pregnancy,
• breastfeeding,
• suntan (1 month),
• sun-sensitizing drugs (retinoids, tetracyclines),
• herbs (St John's wort, calendula, stop using 2-3 weeks before the treatment),
• alcohol consumption (24 hours before the treatment),
• unstable diabetes,
• vitiligo,
• psoriasis (active phase),
• epilepsy,
• blood coagulation disorders, use of medicines reducing blood coagulability,
• skin prone to formation of keloids;

During pre treatment consultation your doctor will do the following:

• gather patient's medical history,
• describe the procedure and explain its nature,
• evaluate the lesions to be removed,
• settle possible contraindications to the treatment,
• explain potential side effects,
• realign patient's expectations;

Before the procedure:

• avoid sunbathing (the sun, solarium) at least 4 weeks before the treatment,
• do not remove hair before the laser hair removal treatment (waxing, tweezers); you may shave the target hair or use chemical depilatories,
• moisturise the skin properly before the procedure (dietary supplements, moisturising creams),
• do not drink alcohol on the day of the treatment (alcohol negatively influences the course of laser therapy),
• it is advised to stop using creams containing retinol a month before your scheduled treatment,
• peeling - do not use for at least a week before the treatment,
• the target hair should be shaved on the day before the procedure.

During the procedure:

Patients may experience slight burning sensation, which may be reduced in cases of more sensitive patients or in sensitive skin areas by applying local anaesthesia (e.g. EMLA cream). This should be arranged with your doctor before the treatment. The duration of the procedure varies depending on the treated skin area.

Possible side effects:

• at the very moment of laser shot on the skin, patients may feel discomfort, whose intensity and character will vary: stinging, burning, itching (sometimes persisting up to an hour after the procedure), most patients tolerate these sensations well, some will need anaesthesia,
• redness and swelling may occur after the procedure, as its direct effect; these will last from a few hours to a few days - after the procedure, cold compresses, so called cold packs, are applied, while at home patients use moisturising creams and thermal water,
• immediately after the procedure, patients may experience itching, especially around nose and cheeks,
• increased sensitivity of the skin after the procedure (it is advised to avoid the risks of skin injuries);

Complications:

• very rare, in 2% of patients,
• skin abrasions - there may occur blisters and scabs, which take about 10 days to heel,
• there might appear bruises on the irradiated skin area, which usually resolve within 5-15 days; brown skin discolouration may persist up to 3 months,
• changes in skin pigmentation - discolouration or depigmentation, usually in patients who are tanned or with dark complexion, in some patients, hyperpigmentation may occur even though the skin was protected against the sun (usually disappears within 3-6 months, however, in very rare cases, it may become permanent),
• scarring - may occur in patients with a tendency to keloid formation,
• skin infections - may appear on the irradiated skin area (in carriers of herpes the virus may be activated);

Skin-care directions after the laser treatment:

• patients are recommended to avoid sunbathing for at least 4 weeks following the treatment,
• protection from the sun: unconditionally, it is necessary to protect the treated skin from the sun for at least 1 month after the procedure, using sunscreen SPF 50+,
• physical exercises, sauna: it is advised to avoid factors potentially causing dilation of blood vessels for 4-5 days,
• skin moisturising: after the procedure, patients should moisturise the skin with moisturising skin-care preparations 2-3 times a day,
• make-up: in cases of damaged skin, it is advised to avoid applying make-up on the irradiated skin areas for about 4-5 days following the procedure, in the remaining cases, make-up may be applied the next day after the treatment,
• heeling process: in very rare cases of scabs occurring on the skin it might be necessary to use an antibiotic ointment; in very severe itching, mild steroid ointment; these drugs are then prescribed by a doctor,
• follow-up consultation: after about 4-6 weeks, patients should come for a follow-up medical consultation, evaluating effects of the treatment and to get possible indications for further treatment;

For a few days following the treatment:

• do not use soap, surgical spirit or alcohol-based lotions,
• do not perform peelings,
• do not wipe the treated skin areas with a sponge or towel,
• do not cause skin irritation within the treatment area;

Contact your doctor promptly if you notice any signs of complications!

Frequently Asked Questions - laser treatments

How do lasers work in aesthetic dermatology?
Lasers operate using the phenomenon of selective photothermolysis. It means, that the light emitted by the laser is absorbed by pigments contained in the skin. The effect is used in patients for closing dilated blood capillaries and other vascular lesions, while the absorbing pigment is haemoglobin, or for removing discolouration or hair, where the absorbed pigment is melanin.

How does laser "know" whether to remove skin discolouration or hair, since both of the skin structures contain the same skin pigment - melanin?
Different laser types have different wave lengths. These parameters determine the depth of laser beam penetration into the skin. In cases of skin discolouration, most often, lasers operate within the epidermis, therefore, the lasers with shorter wave lengths are applied (e.g. 532, 585 nm), while for hair removal, we use lasers which penetrate the skin deeper (e.g. 755, 810 nm).

How can lasers differentiate between haemoglobin and melanin?
Each of the pigments has its own spectrum of absorption (absorption of laser light). Haemoglobin presents the highest absorption spectrum of 530-590 nm (first absorption pick) and 900-1100 nm (second pick). In the case of melanin, the spectrum has no picks, however dermatology uses the lengths of waves, where the melanin absorption is high, while haemoglobin absorption very low. It takes place within the scope of 670-850 nm.

What types of lasers are available nowadays?
Starting from the lasers with the shallowest action, these are the following:

• 4 nm - argon laser (no longer applied at the present time)
• 532 nm - Nd:YAG laser with a second harmonic - KTP (telangiectasis, epidermal discolouration)
• 585 nm - dye laser (vascular changes, mainly haemangiomas)
• 694 nm - ruby laser (discolouration, hair removal) - currently rarely used
• 755 nm - alexandrite laser (hair removal)
• 810 nm - diode laser (hair removal)
• 1064 nm - Nd:YAG laser (venulectasias, dilatation of vessels on the legs)
• 2940 nm - Erbium YAG laser (dermabrasion)
• 10600 nm - laser CO2 (dermatosurgery, skin resurfacing)

What is IPL?
IPL (intense pulsed light), in other words intensive source of light, which practically is not a laser. Lasers emit a single wavelength (e.g. 810 nm, 1064 nm), so monochromatic light, while the IPL cut-off filters in the handpiece change the wavelength range allowing it to be optimized for different applications and skin types. The range of wavelengths of IPL varies from 515-1200 nm. Using shorter filters the light penetrates only the epidermis, enabling the treatment of vascular lesions and discolouration. Longer filters are used for hair removal.

Who may undergo laser treatment?
Laser treatments are practically for all patients, who do not show contraindications to the treatment. The most important contraindications include tanned skin, unstable diabetes, epilepsy, using anticoagulant and sun-sensitizing medicines (e.g. tetracycline, herbs: calendula, St John's wort).

Can the laser treatments be performed in pregnant women?
The influence of laser therapy on foetus has not been investigated yet. It seems unlikely, that they have any effect on the state of pregnancy (lasers operate only within the level of skin). Though, adverse effects cannot be excluded, what is more, it would be difficult to treat possible complications, therefore such treatments are not performed during pregnancy. Additionally, it should be considered, that laser therapy during pregnancy does not make sense, as the state of pregnancy itself stimulates pathological changes on the skin (e.g. dilated capillaries, chloasma, possibility of new hair follicles).

What if during a series of laser treatments a patient discovers she is pregnant?
The patient should then inform her doctor and stop the therapy for the time of pregnancy. Continuation of the lase therapy will be possible after the breast feeding period.

Are there any age restrictions?
There are no such limitations, although, because laser treatments are associated with some discomfort and sometimes with pain, they are usually not suitable for children. Additionally, patients should consider necessity of some laser treatments at a very young age. And so, e.g. haemangiomas on the skin are recommended for a few year observation, as, most often, they are absorbed spontaneously. While hair removal in a teenage patient, who has not entered puberty yet, will necessitate in at least a partial repetition of the therapy after the puberty and related hormonal imbalance.

Who may perform laser treatments?
In majority of cases, the treatments are medical procedures, therefore, they should be performed by a doctor. Some lasers may be operated by middle-level medical personnel (e.g. nurse, physical therapist), however, each time, the therapy should be preceded and followed by a medical consultation.

Are the e.g. IPL treatments performed by beauticians effective?
Yes, the are, providing that the beauticians cooperate with doctors, preferably dermatologists. In case of complications, no beautician will be able to help, as they do not have adequate scope of medical knowledge nor they have permission to write prescriptions. It should be also considered (which patients usually do not know), that so called cosmetic lasers generate low-level energy. Therefore, even though they offer gentle treatment, without complications, at the same time, they might not work effectively to eliminate target skin conditions. For example: Medical IPL devices may deliver energy up to 90 J/cm2 (the energy of 40-45 J/cm2 is often applied), while the cosmetic lasers reach maximally 25-30 J/cm2. The difference in treatment effects is spectacular.