Lasers have a wide application in the field of dermatology, with the world ‘laser’ itself standing for ‘light amplification by stimulated emission of radiation’. Lasers of various types are also further differentiated depending on what element is used as a medium in its radiation, each with specific wavelengths that target specific chromophores - atoms that affect the color of compounds found in cells.
Which laser is used in your skin treatment varies according to wavelength, penetration depth, pulse parameters (intensity and duration), and the severity of the treated condition.
According to what skin treatment is desired, a different laser is used, and is classified accordingly:
The Pulsed Dye Laser (PDL) is intended to treat vascular lesions. The targeted chromophore is the hemoglobin in the blood. Its lasing medium consists of an organic dye (such as rhodamine and fluorescein) mixed with a solvent (water, glycol, or ethanol). The emitted light stimulates the dye particles to emit radiation that heats and destroys the damaged blood vessel. The body will subsequently absorb the damaged tissue. The Pulsed Dye Laser produces a light of 585 or 595 nm wavelength with a pulse duration of 0.45–40 ms.
The Pulsed Dye Laser is safe for all skin types and colors. However, this treatment is advanced, and caution is advised if applied to people with dark skin. Darker skin contains more melanin which increases the risk of hypopigmentation in the treated area (the treated area will appear lighter).
The Pulsed Dye Laser targets hemoglobin in the blood - as it is one of the body’s most distinct sources of chromophores - destroying the diseased blood vessel. It has a short wavelength which makes it ideal for cutaneous lesions. It also does not affect the surrounding structures.
The indications for Pulsed Dye Laser include:
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The Pulsed Dye Laser is a safe, non-invasive treatment with minimal side effects such as:
Mechanism of PDL:
A lasing medium is ‘excited’ - a process causing electrons to move from a low to high orbit around an atom - to produce a laser beam. An organic dye and solvent are used as the medium in the case of PDL.
The organic dye may be rhodamine, fluorescein, coumarin, stilbene, umbelliferone, tetracene, or malachite green. The solvent options include water, glycol, ethanol, methanol, hexane, cyclohexane, and cyclodextrin.
The excitation source may be an electrical charge or another type of laser.
Once excited, these particles produce the laser pulse that is a yellow light of a single wavelength (585-595 nm). This specific wavelength targets the oxyhemoglobin in the blood.
PDL treatment relies on the selective thermolysis concept, where the light produces heat that destroys the targeted blood vessels without causing damage to the surrounding tissue. The body then eliminates this tissue through normal blood flow via healthy blood vessels.
PDL procedure:
A thorough cleaning of the face is mandatory to remove makeup, cream residues, and facial oil.
The process is usually painless, though sometimes results in minimal discomfort likened to an elastic band snapping against the skin. For more comfort, your dermatologist may apply a numbing cream. Also, the PDL device produces a cold spray or puff before the pulse to reduce pain.
Your dermatologist will give you protective eye goggles to wear. During the session, short pulses are applied to the intended area in a non-overlapping method to avoid burns.
The session lasts just a few minutes. A cold pack is applied to the treated area once the session is over.
The required number of treatment sessions depends on the size and severity of the problem. The average number of required sessions ranges from 1-3. Touch-up sessions may be scheduled to maintain the results.
The results appear gradually because of the post-operative bruising. Following several days of allowing the bruising to heal, results will become noticeable, and will continue to improve with time.
The difference between Pulsed Dye Laser (PDL) and Intense Pulsed Light (IPL):
Intense Pulsed Light (IPL) is a painless procedure where the emitted light targets the blood vessels or melanin in the skin. It aims to destroy blood vessels such as spider veins, and stimulates collagen production for a younger look.
The main difference between PDL and IPL is the nature of the emitted light. PDL produces a monochromatic (single wavelength) yellow light, which is more effective, specific, and intense. On the other hand, IPL emits a polychromatic light (multiple wavelengths), which is less specific but can target several problems simultaneously.
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Pulsed dye Laser treatment is safe for all skin types with minimal side effects. Following the provided pre and post-treatment instructions should spare you from any side effects or complications.
Pain during this procedure is minimal (if any) that can be relieved through the cooling spray integrated into the laser machine and applying a layer of topical anesthetic cream if necessary.
Burn at the treatment site is rare. A proper adjustment of the laser pulse settings would eliminate this risk.
Bruising and redness at the treatment site are not unusual and will fade away within 1-2 weeks.
This technique is used carefully in dark skin color patients to avoid hypopigmentation, which means the treated area appears lighter than the skin color.
This treatment is unsuitable for patients with an active skin condition or history of keloid scarring.
Some rare side effects of this treatment include blistering, crusting, scarring, and infection at the treatment site. If scabs develop, do not attempt to remove them - let them heal naturally to avoid scarring.
Who is an ideal candidate for this procedure?
Patients (any skin type) with vascular lesions are the ideal candidate for this treatment. This treatment is inadvisable for patients with a history of keloid scaring, active skin infection, and dark skin.
How long is the recovery period?
Pulsed Dye laser treatment requires minimal recovery time. You can return to your daily activities the next day.
When can I see the results?
After the session, the treated area may appear red, swollen, and bruised. These side effects take a few days to disappear before you notice results, which will gradually improve with time.
How many treatment sessions are needed?
The number of treatment sessions depends on the severity and nature of the lesion. Mild conditions usually require 1-3 sessions, while more severe lesions may require up to 8 sessions. Touch-up visits may be advised after 6 months to maintain results.
What is the common alternative for Pulsed Dye Laser?
Intense Pulse Light is considered an alternative to Pulsed Dye Laser. Intense Pulse Light is different as it produces a multiple wavelength light, but while it may treat several conditions simultaneously, it may be less specific.