Lasers are a cool technology in search of a use.
-James Sanger, M.D., 2001
Dr. Sanger was one of my professors during my plastic surgery residency. While his cynicism was not unfounded in 2001, I do think that lasers are valuable tools in plastic surgery in 2011.
Why? Because lasers remain the safest and most precise way to get rid of fine facial wrinkles.
Lasers work by focusing energy on particular colors.
- If you want to zap a red capillary, then choose a pulse-dye laser.
- If you want to get rid of a brown age spot, pick up a YAG laser.
- If you want to remove a multicolored tattoo, then you'll need a suite of devices to obliterate the individual pigments.
Focusing on a particular color produces selectivity--photoselectivity. The color absorbs the specific laser energy. Heat is generated. The subsequent burn destroys the pigment, hopefully without damaging the surrounding, non-targeted tissues.
The lasers that purport to remove wrinkles do so by heating the upper layers of skin. Effectively, they create controlled burns from the top down. The resultant healing produces tightening and smoothing.
To a great degree, the result is dependent upon how much of a burn the patient is willing to tolerate.
- If she is willing to undergo general anesthesia and to hide away for a month, then a deep laser-brasion can produce a dramatic rejuvenation.
- But most patients would prefer to avoid "going to sleep." And most don't have a month to spare. Many don't even have a weekend off! As such, "non-ablative" lasers have been developed that produce no more than a sunburn, in order to minimize downtime. The negative is that the corresponding result is much less dramatic.
The biggest problem for the casual patient is the laser marketing. The advertising is so compelling that it's hard even for me to keep track of which product does what. What's true? What's unfounded assertion?
In the next 4 articles in this series, we'll discuss the big picture. I'll divide the rejuvenative lasers into 4 different categories, and I'll discuss the relative strengths and weaknesses of the classes of lasers....
- Traditional ablative
- Non-ablative ("lunchtime" lasers)
- Fractionated ablative
- Novel skin tighteners