The term “laser” more often than not, conjures images of weapons of destruction as popularized in novels, comic strips like Flash Gordon and movies like Star Wars. However, since its invention by American physicist Dr. Theodore Harold Maiman in 1960, laser technology has been used for a host of applications including electronics, data processing, communications, scientific research and as a potent and effective instrument for curing and healing ailments and diseases.
Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Unlike sunlight, which produces various colors of the rainbow when passing through a prism, the laser beam is made up of only one color of light that travels in a single direction --- making it pure, intense and concentrated. The light is produced within an optical cavity containing a medium, which may be a gas (e.g. argon, krypton, carbon dioxide), liquid (e.g. dye) or solid (e.g. ruby, neodymium-YAG, alexandrite, erbium-YAG). The process involves excitation of the molecules of the laser medium, resulting in the release of a photon of light energy. Each medium produces a specific wavelength of light, which may be within the visible spectrum (violet 400 through to red 700 nm) or infrared spectrum (more than 700 nm). Laser light can be accurately focused into small spots with very high energy, which break down, dissolve or destroy a specific target, with minimal damage to surrounding structures.
Dermatologists were among the first in the medical world to use lasers. The choice of the type of laser depends on the treatment required and sometimes, several lasers may be used for one specific treatment based upon the need for a certain wavelength or pulse duration. Lasers can be used for treating skin problems such as unsightly moles, freckles, age spots, tattoos, vascular lesions, hypertrophic or keloid scars, wrinkles, pigmented birthmarks and for skin re-surfacing purposes. Lasers can also be used for hair reduction (quite commonly on the upper lip, armpits and legs).
With laser technology, it is now possible to satisfactorily eliminate some of the aforementioned skin conditions without need for surgery, thereby minimizing the risks of infection, bleeding, swelling and eliminating the need for general anesthesia or local infiltration anesthesia. These advantages have made laser treatment an increasingly appealing option for many patients.
Evidence of the emerging popularity of laser treatments is the fact that lasers can now be found not only in hospitals and skin clinics, but also in spas and beauty centers. Further, the public is bombarded with advertisements of lasers --- genuine or otherwise. In extreme cases, there have been instances of abuse of the use of the word “laser” by some establishments that advertise any form of light emitting equipment as a laser, in order to draw in clients.
As more people are enticed to undergo laser treatment they should understand that there is a potential for injury and ill effects from its usage. Dr. Maria Angela Cumagun warns, “You need to be cautious. Lasers are not as harmless as some people may make you believe.”
In fact, in the United States, where the skin laser treatment industry is now a 2 billion dollar-a-year business, complaints are cropping up, with a number of patients being injured by laser treatments done in spas and beauty salons by individuals with inadequate training. Complications include hyperpigmentation or hypopigmentation, blister formation and bruising, which are usually temporary. Major complications include infections, 2nd and 3rd degree burns and scarring. A potential complication that could be overlooked is the possibility for retinal injury (injury to the visual “screen” of the eye).
The potential for retinal injury while using laser devices increases when the specific treatment requires the use of more than one wavelength of laser light, such as in tattoo removal. Typical laser eye protection is wavelength specific. Hence, some laser eye protectors do not necessarily protect against certain types of lasers. The hazard arises when the laser eye protection does not protect against the wavelength being used for treatment. Due possibly to fatigue or a lack of situational awareness, the simple task of switching to the appropriate laser eye protector for the laser being used, or insuring the laser eye protection offers multi-wavelength protection, may not always be rigorously followed. As a result, retinal injuries have been alleged.
It is highly advisable therefore, that before undergoing a dermatological laser treatment, a consultation with a board certified dermatologist should be done. The dermatologist, after thoroughly evaluating the patient, will give an assessment and diagnosis, and discuss all the treatment options available. If laser treatment is the best option, the dermatologist will then also discuss what the patient should expect from the treatment and any possible complications.
It has to be borne in mind that not all establishments with the latest laser equipment will also have the qualified people to operate these machines. Dr. Cumagun further advises, “The patient should not be afraid to ask questions and to check the credentials of the person who will be performing the treatment. That person should not merely be able to operate the laser machine but should also know which laser would be best suited for a particular skin problem and a particular skin type.”
Overall the best person to perform laser treatment for skin problems is a doctor who is board certified in dermatology, or another specialty with equivalent training. In addition, she should have undergone further training in laser treatment, and be familiar with the different types of laser machines, their indications and proper usage. As not all skin disorders can be treated with lasers, the dermatologist is in the best position to judge whether their use will be beneficial to the patient.