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Dermatology
Lasers and Other Energy-Based Therapies
Built from Dermatology, 5th Edition
What’s inside
15 sections · 135 slides
Overview
- What this topic covers
- The energy-based toolbox
- How a laser hits its target
- Laser wavelengths across the light spectrum
- Why early continuous lasers caused scars
Core Laser Devices
The pulsed dye, KTP, Nd:YAG, and intense pulsed light systems used across dermatology
- Pulsed dye laser (PDL)
- KTP laser: bruise-free vessel treatment
- Nd:YAG laser: reaching deeper vessels
- Intense pulsed light (IPL)
- Dyspigmentation risk with inappropriate IPL
- IPL treatment of lentigines (age spots)
- Using IPL safely
Ablative Resurfacing
CO2 and Er:YAG lasers that vaporize skin to treat wrinkles, scars, and benign growths
- Water is the target for resurfacing lasers
- First pass versus later passes
- CO2 laser versus Er:YAG laser
- Ablative CO2 laser resurfacing for facial wrinkles
- What ablative resurfacing can treat
- Ablative erbium:YAG laser for syringomas
- Risks of ablative resurfacing
- Preventing infection after ablative resurfacing
Fractionated Lasers
Treating skin in thousands of tiny columns instead of all at once - safer, faster healing
- What fractionated photothermolysis is
- How an MTZ heals
- Non-ablative fractional lasers
- Ablative fractional lasers
- Examples of fractionated laser and radiofrequency devices
- Examples of fractionated laser and radiofrequency devices (continued)
- Examples of fractionated laser and radiofrequency devices (continued)
- Pin-point bleeding during fractionated CO2 treatment
- 12%
- Treating acne scarring with fractional lasers
- Non-ablative fractional laser for scar remodeling
- Fractionated CO2 resurfacing of sun-damaged skin
- Fractionated CO2 for acne scarring in darker skin
- Volume reduction and drug delivery
Chronic Photodamage
Treating the cumulative effects of sun exposure - spots, redness, and fine wrinkling
- Maintaining a youthful appearance with IPL
- Ablative versus non-ablative for photodamage
- KTP and Nd:YAG for skin texture
- Fractionated ablative CO2 laser for photodamage
Vascular Lesions
Birthmarks, hemangiomas, rosacea, spider veins, and other blood-vessel skin problems
- Targeting blood vessels with light
- Purpura versus purpura-free treatment
- Lasers and other devices used for the treatment of vascular lesions
- Lasers and other devices used for the treatment of vascular lesions - clinical applications
- Lasers and other devices used for the treatment of vascular lesions - clinical applications (continued)
- Lasers and other devices used for the treatment of vascular lesions - clinical applications (continued)
- Lasers and other devices used for the treatment of vascular lesions - clinical applications (continued)
- Port-wine birthmarks (PWBs)
- The history of port-wine birthmark treatment
- Port-wine birthmark treatment settings
- Pulsed dye laser treatment of a port-wine birthmark
- Why early treatment of birthmarks matters
- Infantile hemangiomas: what they are
- Treating infantile hemangiomas
- Facial telangiectasias (visible small vessels)
- Rosacea-related facial redness treated with PDL
- Poikiloderma of Civatte
- Footprinting after pulsed dye laser treatment
- "Footprinting" - an uneven laser pattern
- "Spider" veins of the leg
- Pyogenic granulomas, venous lakes, and cherry angiomas
- Laser treatment of warts (verrucae)
- Managing pain during vascular laser treatment
Pigmented Lesions
Freckles, birthmarks, nevi, and melasma - how melanin-targeting lasers work
- Targeting melanin with light
- Lasers and other light-based devices used for the treatment of pigmented lesions
- Ephelides (freckles) and lentigines (age spots)
- Lentigines before a single Q-switched ruby laser treatment
- Lentigines six weeks after a single Q-switched ruby laser treatment
- Benign melanocytic nevi (moles)
- Café-au-lait macules and nevus spilus
- Nevus of Ota, nevus of Ito, and blue nevi
- Why melasma is hard to treat
- Laser options for melasma
- Becker melanosis and postinflammatory marks
Hair Removal
How photoepilation destroys hair follicles, and how to choose the right device and settings
- Laser hair removal: scope and goals
- How a laser destroys a hair follicle
- Choosing the right wavelength
- Matching pulse duration to the follicle
- Long-term hair reduction after laser treatment
- Outcomes and side effects of laser hair removal
- Paradoxical hypertrichosis
- Preparing skin for photoepilation
Scars, Striae, and Cellulite
Matching laser choice to the type of scar, and the limits of laser treatment for stretch marks
- Matching laser to scar type
- Treatment by scar feature
- Striae distensae (stretch marks)
- Cellulite treatment
Tattoo Removal
How Q-switched and picosecond lasers shatter ink particles, and how color guides device choice
- What a tattoo is, and why removal is hard
- How a Q-switched laser breaks up ink
- Immediate tissue whitening after Q-switched laser treatment
- Picosecond lasers
- Matching laser color to ink color
- Tattoo pigments, lasers used for their removal, and potential complications - pigment composition
- Tattoo pigments, lasers used for their removal, and potential complications - pigment composition (continued)
- Tattoo pigments, lasers used for their removal, and potential complications - pigment composition (continued)
- Tattoo pigments, lasers used for their removal, and potential complications - pigment composition (continued)
- Tattoo pigments, lasers used for their removal, and potential complications - lasers and complications
- Tattoo pigments, lasers used for their removal, and potential complications - lasers and complications (continued)
- Tattoo pigments, lasers used for their removal, and potential complications - lasers and complications (continued)
- Tattoo pigments, lasers used for their removal, and potential complications - lasers and complications (continued)
- Q-switched and picosecond lasers by tattoo ink color
- Speeding up tattoo clearance
- Amateur versus professional tattoos
- Complications of tattoo removal
- Paradoxical darkening of pink tattoo ink
Psoriasis and Vitiligo
How a targeted ultraviolet laser treats stubborn plaques and depigmented patches
- Excimer laser for psoriasis
- Excimer laser for vitiligo
Safe Practice
Preoperative screening, anesthesia, wound care, and how to prevent complications
- Before any laser procedure
- Anesthesia and eye protection
- Postoperative wound care after ablative treatment
- Preventing infection and scarring
- Managing dark marks after treatment
Radiofrequency and Ultrasound
Non-laser energy that heats the deep skin to tighten it, without breaking the surface
- Monopolar radiofrequency (RF)
- Improving RF comfort and reliability
- Bipolar RF and ultrasound tightening
- Two flavors of ultrasound tightening
- Radiofrequency microneedling
Microwaves
Selectively heating sweat glands with microwave energy, sparing the fat layer beneath
- Microwave sweat-gland treatment
- 90%
- MiraDry side effects
Home Devices and Emerging Technology
Consumer lasers, sebum-targeting devices, and a nanosecond electrical technique
- Home-based laser and light devices
- New approaches to treating acne
- Nano-pulse stimulation (NPS)
- Cellular death after nano-pulse stimulation
- Key takeaways
- References
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- Dermatology, 5th Edition (2-Volume Set)