The following is an excerpt from the Glow Journal podcast. To listen to the full interview, subscribe now on iTunes or Spotify
Professional skin clinics are finally back open and the festive season is almost upon us, so we’ve received an influx of questions recently regarding skin treatments for everything from hair removal and skin tightening through to pigmentation and spider veins.
In this edition of our Ask An Expert series, we’ve taken your questions to Candela Medical ANZ’s National Clinical Operations Manager, Kirsten Cachia. Kirsten Cachia is Candela Medical’s National Clinical Operations Manager and an undisputed expert in all things laser, and although this episode is sponsored by Candela, you won’t hear Kirsten recommending any specific products, machines or treatments. As per the rest of this Ask An Expert Series, I’ve sought experts to give you objective answers to your questions so that you can take that information and make educated decisions regarding which treatments are right for you.
In this conversation, we’ve taken the questions YOU submitted on all things laser and IPL to Kirsten- from the difference between laser and IPL, whether one is better than the other and if it’s even worth undergoing a hair removal treatment so close to summer, through to how lasers effect pigment, what’s involved with a spider vein treatment, and whether or not laser treatments are really permanent.
GLOW JOURNAL: What is laser? When we hear people talking about laser treatments for the skin, for hair removal, so on and so forth, what actually is this laser they’re talking about? And is it true that laser is actually an acronym?
KIRSTEN CACHIA: Yes, it is an acronym. That acronym stands for Light Amplification by Stimulated Emissions of Radiation. Laser is actually a wavelength of light on the magnetic spectrum. It is monochromatic. It is non divergent. It is coherent. What that means is that it travels in time in one direction, in waves that are identical every time. This makes laser intense.
So, how does laser differ from IPL? And, on that note, what is IPL?
Laser and IPL are very different. IPL stands for Intense Pulse Light. It’s also on the magnetic spectrum of light, although IPL covers a band of wavelengths, not just one, anywhere between 400 and 1200 nanometers. IPL is many colours. It is non divergent. It is not coherent and, therefore, is not as intense as lasers. So think of IPL as a flashlight in comparison to a laser beam. One would light up a room and the other will be a very small, intense spot on the wall.
Broadly speaking, who would you recommend laser for, and who or for what concerns would you recommend IPL? Is one better or more effective than the other?
Lasers and IPL have come a really long way over the years and they are great in the aesthetic industry for many indications. What we need to do is understand the indication, the chromafore, the skin concern you are treating and the skin type of the person. Then you can choose the laser wavelength that is going to be suitable. To think of it in another way, laser wavelengths are attracted to a specific endogenous or exogenous chromophore- either blood, melanin, water or tattoo pigment.
Just for an example, the Alexandrite 755 nanometer wavelength is very attracted to melanin and is therefore widely used for hair reduction. On the other hand, a band of IPL, say from 550 to 750 nanometer wavelengths, covers all of those wavelengths in between and treats the peaks of hemoglobin and melanin. Therefore it’s attracted to both chromophores and it is widely used for rejuvenation. So to answer your question, I don’t think one is better than the other, just more suitable for the treatment and the skin type of the customer.
A listener wrote in saying “I have heard different types of lasers mentioned. What do different lasers do?”
Laser as I mentioned in the last question are attracted to specific chromophores, for instance the pulse dye laser is a 595nm wavelength and is attracted to oxyhemoglobin, it is the gold standard treatment for telangiectasias and rosacea, port wine stains and venus lakes.
The Nd:YAG1064nm wavelength penetrates quite deep and is used for many indications such as LHR, darker, deeper vessels and bulk heating the dermis to achieve neo-collagenesis, as it isn’t hugely attracted to melanin it is also great for the darker skins.
When the wavelengths go past 1100nm they are only attracted to water so for example Candelas CO2 is 10,600nm it is only seeing water and therefore is used for tissue ablation and fractionated ablation.
When I put the callout for questions on the basics of laser and IPL, most people immediately went to hair removal specifically- so let’s start there! How exactly do lasers work to remove hair?
Laser hair removal is based on the theory of Selective Photothermolysis –In other words: we use a specific wavelength that is attracted to the melanin in the hair follicle and once the photons of light have been absorbed by the hair and the stem cells in the surrounding follicle they are converted to heat, this heat will partially destroy the target.
A listener asks “Will laser work for fair skin and light hair? I’ve heard conflicting things!” Similarly, can laser hair removal work for those with dark skin and dark hair?
Best case scenario is dark hair fair skin, that way the light will see the target extremely well and be very successful. That’s not to say you can’t try it on a light brown hair, it might take a few more treatments but you wont be able to treat white hairs, grey hairs and some red heads.
With dark skins that have black hair we get great results with the safe Nd:YAG1064nm but they also might need a few extra treatments and a longer relaxation time to allow for better healing.
Another listener asks “Is laser safe? We’ve had a few skin cancer scares in our family so I’m a bit nervous.” Is there any link between laser and cancer? Or even sunburn?
If you have a history of skin cancer in the family it is best to have a skin check at your local skin cancer clinic before embarking on any laser treatment. A laser can burn the skin if not used correctly, it is very important to follow the guidelines to ensure best outcomes.
lasers are non-ionizing radiation so cannot cause or stimulate cancer cells, although it is a definite contraindication to laser over a raised lesion or a lesion that you cannot diagnose. As always follow your guidelines and check for any contraindications, tans, fake tans, sunburn, are all contraindications and if you are concerned about a specific lesion then refer them to a Dermatologist.
Can we expect to see any side effects after laser hair removal?
Laser hair reduction can come with some erythema and swelling around the follicles which usually only lasts 2-24hrs. There will also be a sensitivity to UV radiation so keep the area out of direct sunlight and wear a sunscreen if the area is exposed. Usually, you can return to work straight away as long as you stay cool, wear loose clothing, no rubbing or scratching. If there was an unusual reaction such as excessive swelling, then you need to contact the clinic straight away.
A listener writes “I want to get laser, but is it pointless now that we’re so close to summer? I know you can’t go in the sun afterwards, so should I just wait until next year?” So, bouncing off that question- What time of year do you recommend treatments? And why?
This is a good point especially if you live in a warm climate, work outdoors and or spend a lot of time outdoors in summer. In this case it is recommended that you wait until April or May and continue your treatments throughout the winter months. If you work indoors and stay out of the sun and are sun smart, then you can still get LHR all year round. Tanning and laser definitely do not mix and if you do then it will quite possibly result in hyperpigmentation or even worse hypopigmentation.
Another asks “I know I can’t have fake tan on, something about it burning. Why is that?”
Pigment is pigment whether it is a real tan, fake tan, bronzer etc, the light will still be absorbed by the brown color and potentially burn the skin.
How many hair removal treatments do you find that clients usually need, and are the results permanent?
The FDA approved the term Laser Hair Reduction as there is a chance there will always be a small percentage of hairs regrowing. The hairs have a cycle of growth going through 3 stages. Different areas stay in one stage longer than others so therefore might need more treatments. Hormones govern hair growth and if something changes after a course of treatments, they might stimulate hair growth, this could be the result of an illness, medications, pregnancy, menopause to name a few. In general 8-10 treatments is common as long as the treatment procedure is performed correctly.
Let’s move on to laser and IPL for the skin, as opposed to the hair. What are some of the most common skin concerns that are treatable by laser?
Benign pigmented lesions such as freckles, dyschromia, poikiloderma, solar lentigo, in other words most sun damage, vascular lesions, rosacea, acne, scars, stria and wrinkles are the main concerns treated by IPL and lasers.
Pigmentation is definitely the skin concern that popped up the most in our listener-submitted questions. One listener says “I’ve tried every product possible to fade pigmentation, but I want to get a clinical treatment now that salons are open. Should laser be my first port of call, or should I try something like a peel?”
Speak to your clinician and ask what the options are according to the skin consultation that they do, depending on the diagnosis you might need to prep for a few weeks before having a laser treatment that might include peels and pigment inhibitors.
So, how do lasers affect pigment? What does a pigmentation treatment entail?
There are a few lasers that treat pigmentation, 2 that we use are long pulse and picosecond lasers.
Long pulse thermal devices will denaturate the pigmented cells which will cause darkening and desquamation of the micro-crusts with cell turnover. This usually takes approximately 14 days to resolves and a further 2-4 weeks before you can see the results or retreat if necessary. A picosecond device with a short pulse duration and high peak power will cause a pressure wave to shatter the pigmented cells and trigger an immune response to clear away the cell debris over the next 4-6 weeks eventuating in a gradual fading of the pigmented.
A listener has written in saying “I want laser for pigmentation, but I’ve also heard that laser can cause hyperpigmentation. Is this true?!”
There are always risks to any laser treatment for pigmentation, there needs to be a thorough consultation and a strict compliance to a post care regime to prevent hyperpigmentation.
And are the results permanent? How many treatments do we need before we start seeing results?
Again results will depend on what has caused the pigment and compliance to post care, we usually recommend a course of 3-4 treatments.
A listener wrote in saying “I’ve had great results from laser for my pigmentation, and now I want to have a surgical scar removed. Is the treatment for scarring similar to the treatment for pigmentation?”
Any type of scar is a result of trauma to the dermis which results in scar tissue and a contracture and tightening of the collagen fibres. If the scar is pigmented then you can use a laser or IPL device to reduce brown pigment or vascular damage, if the scar is raised then a fractional laser is probably the way to go to slowly flatten the scar.
Spider veins were the next most-frequently-asked about concern. How does a laser treatment for visible veins work?
Vascular lesions are treated with a thermal device and the mechanism is coagulation of the vessel and a denaturation of the vessel wall, the wound repair process will clear away the cell debris resulting in a clearance of vessels.
And are there any side effects or downtime?
All laser treatments have a certain amount of downtime, the more aggressive the more downtime, it is very important to follow the post care advice and stay out of the sun.
Skin tightening and treatments for mature skin also popped up a bit. How do these sorts of treatments work?
Skin tightening treatments range from non-invasive to invasive depending on the laser and the type of treatment. The non-invasive treatments can be a bulk heating of the dermis to stimulate collagen or acoustic fractional treatment that create optical cavities in the dermis which results in plasma formation and a better organized dermal collagen structure. Invasive skin tightening treatments can result in longer downtime due to the intensity and heat which can cause resurfacing as well as coagulation and bulk heating in the dermis.
Finally, what would your advice be to anyone who has been looking into laser or IPL treatments, for hair removal or for the skin, but is feeling a little bit nervous about it?
I would advise them to research a reputable practitioner and have a skin consultation, ask questions about treatment procedure, post care, look at before and after photos and then decide.
To listen to the full interview, and the rest of our Ask An Expert series with Candela Medical, subscribe to the Glow Journal podcast now on iTunes or Spotify
