Lasers in Dermatology: Parameters and Choice: With Special Reference to the Asian Population

204 Pages·2023·12.085 MB·English

by  Jae Dong Lee, Min Jin Maya Oh

Lasers in
Dermatology:
Parameters
and Choice
With Special Reference to
the Asian Population
Jae Dong Lee
Min Jin Maya Oh
123
Lasers in Dermatology: Parameters
and Choice
Jae Dong Lee • Min Jin Maya Oh
Lasers in Dermatology:
Parameters and Choice
With Special Reference to the Asian
Population
Jae Dong Lee Min Jin Maya Oh
MISODAM Clinic ARA Clinic
Daejeon, Korea (Republic of) Incheon, Korea (Republic of)
0th edition: © MDWORLD Medical Publishing Co. 2022
ISBN 978-981-19-7567-7 ISBN 978-981-19-7568-4 (eBook)
https://doi.org/10.1007/978-981-19-7568-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Singapore Pte Ltd. 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specifically the rights of reprinting, reuse
of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical
way, and transmission or information storage and retrieval, electronic adaptation, computer
software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
Preface
I have conducted 11 'Laser Hands-On Courses' from July 16, 2016, to
September 1, 2018, which ran for 1 night and 2 days. A total of 70 people
came, and most of them were beginners who were new to lasers. They were
not interested in the complex principles of a laser, but a parameter that they
could apply right away tomorrow. 'Lasers in Dermatology: Parameters and
Choice' describes the specific laser parameters for beginners, focusing on
each laser instrument. However, since safe and effective laser treatment is not
possible simply by memorizing parameters, I have also described an impor-
tant principle that is essential for parameter control.
Since this book is based on the content of 'Lasers in Dermatology: Choice
and Treatment (Korean)', it can be seen as a summary of 'Lasers in
Dermatology: Choice and Treatment (Korean)'. For more information, please
refer to ‘Lasers in Dermatology: Choice and Treatment (Korean)’.
Since the book needs to describe parameters in detail, I have written down
the parameters for specific laser products. However, because each laser prod-
uct has different parameters, it should not be applied to your own laser, but
should be adjusted accordingly taking into account the principles of the laser.
There are also some laser instruments in the book that I do not use. For these
products, the parameters provided by the laser company and the parameters
used by various practitioners were taken into account, as well as principle of
lasers. I would like to take this opportunity to express my gratitude to Dr. Min
Ho Lee of Besttop urology clinic, Dr. Seung Choi of Ciel clinic, and Dr. Yong
Ho Hwang of Wellskin clinic who generously informed me of their parame-
ters and know-how.
The first stage of skin laser treatment is the correct diagnosis of the lesion.
However, since this book does not explain the diagnostic criteria or methods
of diagnosis, beginners should study the diagnosis of skin diseases addition-
ally. And consultation method is also very important for beginners.
Consultation methods vary from practitioner to practitioner, and there are
diverse and unique consultation methods. But I didn't include these this book
because I thought that it could be an obstacle to your individual creative con-
sultation methods.
Finally, even though it is becoming increasingly difficult for private prac-
tices, I hope that my book may be a small beacon for private practice laser
physicians. Let's all shout a Korean cheer!
v
vi Preface
Aza Aza Fighting!
I would like to send my love to my wife Mi Ran and my sons Jeong Jin and
Yoo Jin.
Daejeon, Republic of Korea Jae Dong Lee
31 July 2022
Contents
Part I Principles of Laser
1 Six Parameters of Lasers in Dermatology . . . . . . . . . . . . . . . . . . 3
1.1 L ight and Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 E lectromagnetic Radiation (EMR) . . . . . . . . . . . . . . . . . . . . . 4
1.3 L asing Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.4 E nergy Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.5 S kin Optics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.6 S cattering and Spot Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.7 C hromophore and Absorption Coefficient . . . . . . . . . . . . . . . . 9
1.8 L aser-Tissue Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.9 S elective Photothermolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.10 T hermal Relaxation Time (TRT) . . . . . . . . . . . . . . . . . . . . . . . 14
1.11 P ulse Duration (PD) Vs TRT . . . . . . . . . . . . . . . . . . . . . . . . . . 15
1.12 C linical End Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.13 M eanings of Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1.14 S trategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.15 C onclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Part II Choice of Laser and Medical Skin Care
2 Choice of Laser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.1 A esthetic Procedure Selection . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.2 O rder of Laser Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.3 Order of Parameter Selection (Optical Thermal Model) . . . . . 25
2.4 M isconceptions about Peak Power . . . . . . . . . . . . . . . . . . . . . 26
2.5 F luence Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.6 E ffect Versus Safety? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.7 Therapeutic Window and Epidermal Bypass Effect . . . . . . . . 28
2.8 Selection of Pigment Lasers for Koreans . . . . . . . . . . . . . . . . . 29
2.9 S trong and Weak Treatment of Lentigines . . . . . . . . . . . . . . . . 30
2.10 S kin Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.11 T reatment by Baumann Skin Type . . . . . . . . . . . . . . . . . . . . . . 33
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
vii
viii Contents
3 Medical Skin Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.1 Medical Skin Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.2 Homecare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.3 Laser Treatment Response of Pigmented Lesions
and Patients that Should Not Be Overlooked . . . . . . . . . . . . . . 42
3.4 One-Time Treatment Vs Package Treatment . . . . . . . . . . . . . . 44
3.5 Package Therapy and Combination Therapy . . . . . . . . . . . . . . 44
3.6 My Procedure Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Part III Lasers and Parameters
4 Q-Switched Ruby Laser, Absorption Coefficient,
and Spot Size Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.1 Introduction of Q-Switched Ruby Laser . . . . . . . . . . . . . . . . . 49
4.2 Three-Level and Four-Level Lasers . . . . . . . . . . . . . . . . . . . . . 50
4.3 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
4.4 Absorption Coefficient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
4.5 Defocusing Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
4.6 Spot Size Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
4.7 Determination of Spot Size . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
4.8 Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
5 Q-Switched Nd:YAG Laser and Subcellular Selective
Photothermolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
5.1 Overview of Q-Switched Nd:YAG Lasers . . . . . . . . . . . . . . . . 57
5.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
5.3 Subcellular Selective Photothermolysis . . . . . . . . . . . . . . . . . . 60
5.4 Golden Parameter of Laser Toning . . . . . . . . . . . . . . . . . . . . . 62
5.5 One Shot Toning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
5.6 Repeat Pulse Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.7 Focusing Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
5.8 Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
6 Picosecond Alexandrite Laser and Stress Relaxation Time . . . . 69
6.1 Overview of Picosecond Alexandrite Lasers . . . . . . . . . . . . . . 69
6.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
6.3 Plasma-Induced Ablation, Photodisruption,
and Photoacoustic Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
6.4 Stress Relaxation Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
6.5 Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
7 Long-Pulsed Nd:YAG Laser and Arrhenius Equation . . . . . . . . 77
7.1 Overview of Long-Pulsed Nd:YAG Lasers . . . . . . . . . . . . . . . 77
7.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
7.3 Arrhenius Equation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
7.4 Drawbacks of Nonablative Lasers . . . . . . . . . . . . . . . . . . . . . . 81
Contents ix
7.5 F ibroblasts in Papillary and Reticular Dermis . . . . . . . . . . . . . 81
7.6 P arameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
8 Pulsed Dye Laser (PDL) and Macropulse . . . . . . . . . . . . . . . . . . . 87
8.1 O verview of PDLs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
8.2 I ndications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
8.3 M acropulse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
8.4 A rrhenius Equation in Vascular Therapy . . . . . . . . . . . . . . . . . 90
8.5 R epair and Re-Emergence of Blood Vessels . . . . . . . . . . . . . . 91
8.6 P urpura Threshold and Number of Subpulses . . . . . . . . . . . . . 92
8.7 P arameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
9 Intense Pulse Light (IPL) and Extended Theory
of Selective Photothermolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
9.1 O verview of IPLs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
9.2 R aw Spectrum and Indications . . . . . . . . . . . . . . . . . . . . . . . . 98
9.3 O ptical Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
9.4 E xtended Theory of Selective Photothermolysis . . . . . . . . . . . 100
9.5 M eaning of Multipulse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
9.6 P arameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
10 Long-Pulsed Alexandrite Laser and Thermal
Kinetic Selectivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
10.1 O verview of Long-Pulsed Alexandrite Lasers . . . . . . . . . . . . 107
10.2 I ndications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
10.3 L aser Selection for Epidermal Pigment Treatment . . . . . . . . 109
10.4 T hermal Kinetic Selectivity (TKS) . . . . . . . . . . . . . . . . . . . . 109
10.5 R elation Between Fluence and Pulse Duration . . . . . . . . . . . 111
10.6 P ermanent Hair Removal or Reduction . . . . . . . . . . . . . . . . . 111
10.7 P arameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
11 Er:YAG Laser and Residual Thermal Damage (RTD) . . . . . . . . 117
11.1 O verview of Er:YAG Lasers . . . . . . . . . . . . . . . . . . . . . . . . . 117
11.2 I ndications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
11.3 M echanism of Ablative Rejuvenation . . . . . . . . . . . . . . . . . . 118
11.4 W ater Vaporization Threshold . . . . . . . . . . . . . . . . . . . . . . . . 120
11.5 R esidual Thermal Damage (RTD) . . . . . . . . . . . . . . . . . . . . . 120
11.6 T hermal Relaxation Time (TRT) in Ablative Laser . . . . . . . . 121
11.7 E r:YAG Laser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
11.8 P ros and Cons of Er:YAG Laser . . . . . . . . . . . . . . . . . . . . . . 123
11.9 D epth of Ablation and RTD . . . . . . . . . . . . . . . . . . . . . . . . . . 123
11.10 C alculation of Depth of Ablation and RTD
in Er:YAG Laser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
11.11 S pot Size in Ablative Laser . . . . . . . . . . . . . . . . . . . . . . . . . . 124
11.12 P arameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
x Contents
12 CO Fractional Laser and Fractional Photothermolysis . . . . . . . 127
2
12.1 Overview of CO Fractional Lasers . . . . . . . . . . . . . . . . . . . . 127
2
12.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
12.3 Laser Resurfacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
12.4 Comparison of Rejuvenation Methods . . . . . . . . . . . . . . . . . 129
12.5 Fractional Photothermolysis and Melanin Shuttle . . . . . . . . . 130
12.6 Relationship Between Treatment Density
and Side Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
12.7 Parameters of Fractional Lasers . . . . . . . . . . . . . . . . . . . . . . . 131
12.8 FAST Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
12.9 Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Part IV Energy-based Devices and Parameters
13 Fractional Microneedle Radiofrequency and Conductivity . . . . 139
13.1 Overview of Needle RFs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
13.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
13.3 Series Circuit and Parallel Circuit . . . . . . . . . . . . . . . . . . . . . 140
13.4 Conductivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
13.5 Meaning of Parameters in Needle RF . . . . . . . . . . . . . . . . . . 143
13.6 Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
14 Light-Emitting Diode (LED) and Arndt–Schultz Curve . . . . . . . 149
14.1 Overview of LEDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
14.2 Karu’s Photo-Biomodulation Band . . . . . . . . . . . . . . . . . . . . 150
14.3 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
14.4 Arndt–Schultz Curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
14.5 Mechanism of Low-Level Light Therapy
(LLLT) by LED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
14.6 Consensus on LED Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
14.7 Personal Comments on Photomodulation . . . . . . . . . . . . . . . 153
14.8 Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
15 Skin Care Equipment and Calcium Gradient . . . . . . . . . . . . . . . 155
15.1 Overview of Skin Care Equipment . . . . . . . . . . . . . . . . . . . . 155
15.2 Functions of Skin and Keratinocyte . . . . . . . . . . . . . . . . . . . . 155
15.3 Calcium Gradient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
15.4 Iontophoresis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
15.5 Vitamin C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
15.6 Sonophoresis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
15.7 Treatment Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159