Orange County Register

Cosmetic doctors as gourmet chefs? That’s how laser-wielding physicians should think of themselves, according to laser expert Dr. R. Rox Anderson at the dermatology department of Harvard Medical School.

It’s an appropriate image because doctors need to be precise and because they’re applying intense heat – potentially dangerous levels of heat – to achieve the effects they’re seeking.

In the case of laser skin treatments, doctors deliberately damage a portion of the skin to induce the surrounding skin to grow new, healthy skin cells.

“Our job is to be a gourmet chef. We’re cooking people and they have to be done just right. When I’m treating patients I literally think that,” Anderson told doctors today at the “What’s the Truth?” conference on lasers and other cosmetic-medicine procedures in Boston.

Dermatologist Dr. Suzanne Kilmer at UC-Davis focused on the hazards of lasers for patients and doctors. Both of them need to protect their eyes against laser damage.

Kilmer herself has a burned spot on her retina because a stray laser beam hit her when she was wearing the wrong set of protective goggles, which a colleague had given to her, she said.

Sorting through the available options for laser treatments is difficult because the technology is rapidly changing and because each laser company insists that its latest models are the best.

These are some of the wide range of lasers and similar devices that doctors currently use, with some descriptions of them from conference speakers Anderson and dermatologist Dr. Victor Ross of UC-San Diego.

Carbon dioxide lasers. These were the original lasers for repairing aging and damaged skin, but they fell out of favor with doctors and the public after the 1990s. They were effective, but they required weeks of recovery time because they essentially removed the top layer of the patients’ skin.

“What killed the CO2 laser,” Ross said, was a tell-tale line that the laser left between pale treated skin and tanned untreated skin. “Everyone had a friend who looked like that.”

CO2 lasers are still around, but the name is gone.

“Now it’s never called a CO2 laser. It’s called an FX Laser,” Ross said.

Fractional lasers. These computerized lasers drill tiny holes in the skin, creating a dot pattern where the skin grows new cells. They’re used both for repairing damaged skin and for tightening aging skin.

Fractional lasers require less recovery time than CO2 lasers, but produce less dramatic results. Patients can often return to work after a long weekend, Anderson said.

But even fractional lasers cause enough damage to patients’ skin that fluid oozes out of it after the treatment.

Ross told doctors that, when they use a fractional laser in a clinic or medspa, “You’ll want to have a back door for those patients, because they’ll have more oozing and weeping than other patients.”

Fractional lasers are relatively ineffective in eliminating spots on the skin or other pigment problems, Ross said.

Q-switched (doubled) Nd:YAG lasers. These are often used for removing tattoos.

Ulthera System. An ultra-sound device from Ultera Inc. of Phoenix, it’s used for reaching deep layers of the skin that light can’t touch. The machine is in use in Europe, but is not yet available in the United States.

Pulsed dye lasers. These are often used for treating port wine stains, but they require extra care.

“In my experience, they seem a bit treacherous,” Anderson said. “I see [other doctors’] patients coming in with scars after this treatment.”

Excimer. This is the laser with the shortest wave length. It’s used in eye surgery, but also has some uses for skin problems.

Red and near-IR lasers. The Alexandrite laser and others using red and near-infra-red wave lengths are used for hair removal and for eliminating varicose veins, among other uses.

These lasers must be handled with particular caution.

“I know of three dermatologists who are blind in one eye because of these,” Anderson said. “They cause no pain. The first symptom is that you can’t see.”

Hair removal lasers. “They have the strongest laser pulses in all of medicine,” Ross said, “and so they’re the most dangerous.”

Hair removal is the most popular laser treatment in the world, he said.

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