David Gault helped to develop the first depilation laser and new plasma skin resurfacing technology which will shortly be introduced to the UK. Lasers can be used to treat a variety of skin conditions.
Lasers - the word comes from Light Amplification by the Stimulated Emission of Radiation - produce a very powerful light whose energy, according to its wavelength, is absorbed by particular molecules. The beam of the Pigmented Lesion Laser, for example, is tuned to target only the pigment-carrying cells (melanosomes) and destroy them, without affecting adjacent cells and blood vessels. Used correctly, this precision targeting coupled with very short exposure time (a fraction of a second) means there is virtually no chance of scarring.
Tattoos are indelible patterns made on the skin by introducing pigments into its deeper layers. The lasers used to remove tattoos shatter the pigment granules into tiny particles small enough to be removed by the body’s natural scavenger cells. The latest tattoo lasers are able to handle most tattoo colours - professional blue-black tattoos are the easiest to remove, and oranges, greens and yellows are the most difficult.
Normally a test treatment is carried out to establish the lowest effective level of energy needed to remove the tattoo whilst minimising the risk of skin damage and scarring. Once this is established, the number of further treatments required depends upon the size, colour and type of the tattoo.
Treatment is not especially painful, and feels rather like an elastic band being snapped against the skin. A local anaesthetic cream can be used if necessary. Immediately after treatment, the skin may turn white, then become red, raised and tender. Sometimes a crust develops which will separate to leave normal skin after ten to fourteen days.
Thread veins is the name given to the tiny blue, purple or red thread-like vessels close to the skin surface. They can cause immense distress, often disproportionate to their size. Their cause is undetermined, but some individuals inherit the tendency, especially if many spider veins develop at an early age. Standing for long periods, pregnancy, hormonal activity and being overweight may be contributing factors. Some sufferers are so embarrassed by leg veins that they will not expose their legs, and many activities such as swimming and tennis are curtailed. The ideal method of treatment of thread veins depends on their size. There are two methods, laser therapy and sclerotherapy. It is quite normal to use both techniques at different times. Those on the face do best of all; those on the legs are the most difficult to treat. Some lesions cannot be treated at all.
Port wine stains are flat purplish birthmarks which can be found anywhere on the face and body. The stains are caused by abnormal clumps of tiny blood vessels within the skin. Port wine stains and very fine thread veins that sometimes occur in clusters and occasionally look like a red rash are best treated by the pulse dye laser. The laser light targets blood in the vessels, destroying them whilst leaving surrounding structures in the skin undamaged. A small area called a test patch is first treated, and the results examined in about six weeks time. If the vessels have cleared, then further treatment can be arranged. Usually no anaesthetic is necessary; an anaesthetic cream can make the procedure more comfortable. After laser treatment there is always some bruising where the laser beam has struck - the tiny circular purple patches can last for up to fourteen days and sometimes for longer. Occasionally, blood leaks out of newly treated veins and converts to a brown pigment (haemosiderin) which, in the legs, can leave a stain. Iif the problem area is tanned, it is best to wait for the tan to fade before having treatment. Repeated treatments may be necessary and 100% clearing cannot be expected. With full treatment, 60 - 80% clearing is typical. If the area to be treated is very small, it may be neither practical nor necessary to carry out a test patch.
Slightly larger thread veins are treated by injection of an irritant liquid which destroys them - the technique is known as microinjection sclerotherapy. A very fine needle is inserted into the vein under magnification. The walls of the vein are irritated by the solution and swells, blocking the vein. Redness and welting over the treated area takes several days to disappear and the veins slowly fade over the course of around six weeks. The injection may sting a little. Some areas must be treated several times, at six week intervals. Again it is sensible to treat a test patch at the first sitting.
Side effects from sclerotherapy are usually minimal, but may include:
With both techniques, the risk of pigmentation is greater if the skin is exposed to the sun after treatment, and it is wise to wear a TOTAL sunblock on the treated area for at least six weeks, and then to avoid excessive sun exposure for a further six months.
Laser resurfacing using the carbon dioxide group of lasers is a particularly useful treatment technique for fine wrinkles and is a useful treatment for acne scarring. It is less successful at minimising deep icepick scarring and such pits should generally be excised first (three months before laser resurfacing). The scars which result from such excisions can then be included in the formal resurfacing procedure which follows. It is very unusual to restore acne-scarred skin to normal. The deeper the laser resurfacing is taken, the greater the likelihood of pigmentary changes. This takes the form of either a loss or an increase in the skin&s pigmentation, which may be patchy. Nevertheless, a worthwhile improvement can often be achieved.
Laser treatment can be performed under a general or local anaesthetic. If you elect to have a local anaesthetic, you can choose to have no sedation, mild sedation (using a tablet under the tongue), or heavy sedation (using an intravenous injection). Local anaesthetic procedures without sedation or with mild sedation can be performed as an Out-Patient in the clinic. Local anaesthetic procedures with heavy sedation require at least a day case stay. Mild sedation does not require an anaesthetist to be present, whereas heavy sedation does.
Alternatively you may have laser resurfacing under general anaesthetic either as a day case patient or stay overnight. As a general rule, the greater the area to be resurfaced, the more advisable is a general anaesthetic.
The CO2 laser can also be used to remove certain surface blemishes and pigmentation. Because the lesions are literally vaporised, a shave biopsy should first be taken if there is any doubt as to their nature.
Despite many claims, it is unusual to use the laser to totally and permanently remove hair. An average result at the present time is that hair disappears for some two to three months after treatment, and then usually some grows back. Where the response is particularly favourable, the number of hairs growing back is much reduced and they tend to grow at a slower rate and more finely.
The laser works best on dark hair and fair skin, as it is the melanin pigment within the hair which is the target for treatment, but other skin and hair types can also be treated. A number of treatments may be required. Not all skins respond favourably to the laser, however, and only after an initial test patch can your likely response be determined. A test patch involves the treatment of a small trial area to ascertain whether the treatment is helpful and to check that no untoward skin changes occur. In highly pigmented skins the treatment can occasionally cause an increase in pigmentation or a decrease in pigmentation.
The Pigmented Lesion laser is designed to treat superficial brown blemishes and is effective in removing marks like café au lait patches, freckles and some flat pigmented moles.
If the problem area is tanned, it is best to wait for the tan to fade before having treatment. as the tan will absorb some of the laser energy intended for the pigmented lesion. You should therefore avoid exposing to the sun the areas to be treated for at least three weeks beforehand; if you are very tanned, it would be wise to delay treatment until your tan has faded.
Aspiring or anti-clotting treatments designed to thin the blood will increase the likelihood of local bruising after treatment, and so are best avoided for two weeks before treatment. Consult your GP first to ensure that this is in order.
No special preparation is needed. Mr Gault will deliver the laser beam to circular areas about 5mm in diameter. The treatment is not particularly painful - it feels rather like a rubber hand being snapped against the skin - but if the blemish is in a sensitive area, an anaesthetic cream can be used to dull the sensation.
Initially the treated areas become white. They may then crust over, although often the areas heal over without forming a scab. A transient redness or a bruise may occur in the treatment zone. Any discolouration normally fades within 7-14 days.
Repeated treatments may be necessary and 100% clearing cannot be expected. With full treatment, 60 - 80% clearing is typical. The number of treatments will vary depending on the colour of the blemish and its size, but many will be cleared after 4-6 treatments. Some blemishes do not disappear completely, but will be significantly lighter in colour after treatment. If the area to be treated is very small, it may be neither practical nor necessary to carry out a test patch.
The risk of unwanted re-pigmentation is greater if the skin is exposed to the sun after treatment, and it is wise to wear a TOTAL sunblock on the treated area for at least six weeks, and then to avoid excessive sun exposure for a further six months.