LASERS IN PLASTIC SURGERY
There are many rumors about the use of the Lasers in cosmetic surgery, yet no scientific approach has reached the patient that explains the mechanisms and the size of their value using it.
The patient usually is stormed with media information due to marketing reasons, making the impression that Laser is the solution to all problems.
Keeping things as simple as possible, we will try to inform about how lasers work, the range of the results, the specialty of different laser systems, as well as precautionary measures that must one take to avoid possible implications.
Laser is the production and transport of energy to the target organ with the form of a ray of light. The source of the energy determines the frequency of the wave of the ray of light and thus its color. So, you must have heard about Carbon Dioxide Laser (CO2), Ruby, Argon, Er-Yag Laser, etc. These are the materials in which the ray laser is produced. Each material produces its own wave light length, which can be hardly modified according to the size of the tube and the electric energy. Each element of our skin has its own frequency and can absorb only the energy transported with the proper wave length. A great energy absorption leads to evaporation of the element that absorbed it. Water can absorb energy which is produced by the CO2 Laser. Water is part of all the organs and ingredients of our skin, so the laser destroys all the width of the skin that we have pre-selected (laserbation). The CO2 Laser applies to: skin rejuvenation, acme and deep peeling. It clears external pre-selected skin layers according to the generation of the technology of the lasers. Hemoglobin, a substance of the red corpuscles of blood, can absorb energy from Argon or Ruby Lasers, thus, these types of lasers are useful for the Port Wine Stains (Hemangiomas), erythrosis, etc. Ruby or alexandrite laser can be applied to depilation, since the wave length that the laser emits is compatible with that of the hair. The various tattoos with a wide range of colors are perhaps the perfect example of the need to use different types of lasers. Some might notice that some colors are removed while other colors remain. Some color combinations often cannot be removed; they may be modified or mitigated. Colors that might seem simple are complex and can be analyzed by the laser, since it deletes the colors corresponding to its wave length.
Almost every year the companies provide more technologically sophisticated devices of Laser beam production. The computers regulate the exact amount of energy and power, as well as the type of scanning of the skin field. All the above make the laser treatment more effective and keep the side effects at minimum. However, there is a possibility of side-effects when having a laser treatment, as it does not always have an absolutely desirable result. The laser radiation is not ionized, thus it has not the side-effects of ionized radiation. However, the destruction of elements other than the desired is possible, as well the persistence of the elements that should have been eliminated. The greater the specialization of the laser, and the more advanced and sophisticated its technology, the grater is the extent that these problems minimize.
A special reference to the CO2 will be made due to its vast use in deep peeling (rejuvenation). This technique could be exploited for refreshment of the face skin, the reduction of the wrinkles and the normalization of the scars caused by acme. The Erbium-Laser has the same function. This technique, which is called Laserbration, replaced the mechanical way with a “teetotum”. Although this method is more accurate than the mechanical one, no one should regard this technique as the complete solution to the problem, but more as an improvement of the malfunctions ratio, which are at 50-60%. A repetition of the method may follow, if the results are poorer than expected.
The Laserbration technique in all the face area is applied easier and with a more success rate in the surgery with the aid of an anesthesiologist. It creates a burn which is not possible for the patient to bear without a certain amount of anesthesia. The various anesthetic ointments, based in our experience, are not so effective in an area as large as the whole face. The sense of intoxication, which is caused from the anesthesia, is enough for the laserbration treatment. The preparation of the patient obligatory commences 3 days earlier, with antibiotics of vast range to prevent post-operational contamination and with Zovirax (antivirus medicine) to prevent vesicular occurrence. Skin preparation with AHA and clarification ointments may be suggested for two weeks before the operation, although their contribution is ambiguous. A short time after the operation, the patient can go home, having a burn on his face, covered with a transparent membrane. He will have a light sense of burning for a few hours that soon will come off. The laser deactivates the neural ends of the skin, thus the pain caused by the burn would be the minimum. A swelling is developed on the second day, which is continued for a few days. The membrane is taken away the third day. The burn heals in the end of the post-operational week. A redness remains for a month approximately, which can be concealed with make-up. Rarely does the redness remain more than a month, up until six months. The sun protection after the operation is necessary, so as to prevent hyperchromasia, thus the operation is preferably made during winter. Further implications apart from the redness that may remain for up to six months are not expected. Hyperchromasia is not expected, unless effective sun-protection is not applied. Rarely are scans reported from the use of lasers of older technology. Vesicular occurrence is averted through pre- and post-operational treatment with Zovirax. A discoloration is a misfortunate side-effect that is not easily surpassed after a long time.
Another important and common use of the laser is for depilation. All types of laser used for this purpose have results, provided that the proper power of the beams should be selected according to the type of the skin treated. The dark hair removal is easier than the light-colored hair. White hair is unaffected. Hormonal malfunctions before treatment should be checked and be dealt with. The treatment is made without anesthesia; it leaves a small irritation for a few hours and is repeated every 6 weeks. It is possible that over 7 sessions are necessary as it is also possible that the patient may not be relieved from his hairiness and may need a one-session re-treatment.
The use of the lasers for the tattoo removal is irreplaceable and it depends on the principle of energy transport to a target that coordinates on the frequency of the selected laser. The technique must be repeated every 6 weeks. The red color in tattoos is difficult to be removed.
For grog-blossoms, the current treatment is the multiple use of the laser combined with indurative injections, provided that there are no vessel-surgical problems.
Hyperchromasias, melanomas etc, are dealt with the laser successfully.
The use of radio-frequencies has contributed much in the cosmetical surgery. Combined with lasers, enforces them and lessens their side-effects.