1.      What  can lasers do in plastic surgery that a scalpel can’t?

While many think of lasers like a ‘Star Wars’ saber that cuts through tissue, that is not how it is used in plastic surgery. Lasers are not used to cut tissue. While this sounds theoretically appealing, the effects of such heat on the skin cause exactly the opposite of any benefit…tissue burn and delayed healing. Such an effect is of limited use in cosmetic surgery.

The benefits of lasers in plastic surgery are focused on skin-related problems that are not readily treated by any form of conventional surgery. Cosmetic problems of the skin that can not be cut out without severe and undesireable scarring These include facial wrinkles and scars, excessive hair, unwanted tattoos, visible blood vessels, and brown discoloration.

Because of the greater attraction of heat to darker colors, extreme caution must be used in any type of laser treatment in patients of olive, suntanned, or black skin.

2.      How can lasers make my skin look better?

Laser skin resurfacing, commonly called a laser peel, removes the outer damaged layer of skin leaving the way for new cells to appear.  This removal and replacement of top surface skin cells can remove benign growths, reduce the appearance of wrinkles and minimize surface scars. The heat from the laser also has a contraction effect on the deeper collagen layers of the skin which can create some degree of skin tightening.

 The effectiveness of laser skin resurfacing is a function of its depth. Lasers today can be tuned to the depth of penetration or the amount of skin removal desired. From lighter laser skin peels (often call Erbium or microlaser peels) to deeper CO2 laser peels, the results and amount of recovery can be adjusted to each individual patient’s needs and desires. Because of the extended amount of recovery needed for deeper laser peels, a microlaser peeling approach has become popular. The tradeoff of this approach (healing in a week or less) is that a series of treatments are needed to create the best skin smoothing result.

The newest concept in laser skin resurfacing is that of a fractional approach. (e.g., Fraxel) Fractional means that only a fraction of the surface of our skin is actually treated by the laser. The laser burns less skin surface but goes deeper in the areas that are treated. By leaving small areas of untouched skin, healing is much quicker than it would be otherwise. Whether fractional laser resurfacing is better than non-fractional is a matter of debate. The newest lasers are incorporating both approaches in a single treatment.

Any method of laser skin resurfacing requires a good skin regimen for long-term maintenance of the results. This includes a combination of daily topical skin products combined with intermittent microdermabrasions and light chemical peels.

3.      How does laser hair removal work?

      Hair growth can be disabled or destroyed by specific long wavelengths of pulsed laser light. The laser is pulsed for only a fraction of a second so that the energy will be absorbed by the hair follicle but not long enough that too much heat is absorbed by the skin. The result is hair reduction or removal without burning the skin. This creates immediate results that will last far longer than shaving, tweezing, waxing, or chemical depilation, all of which are only very temporary.

One of the most important concepts in laser hair removal is that it requires multiple treatment sessions. This is because the laser works only on hairs that are in their active growth cycle. Since other hairs will enter their growth cycles at different times, additional treatments are needed. The number of sessions may be five to eight, spaced four to six weeks apart.

Because the laser treats many hairs at a time, facial areas (e.g., chin, lip,
cheek) can be treated in ten to fifteen minutes. Small body areas (e.g., underarms,
bikini line) take about  half an hour. Larger body areas (e.g., full back, chest,
full legs, both arms) usually an hour or more, depending upon the size
of the area and the density of the hair. No matter how it is marketed, laser hair removal is uncomfortable and topical anesthetics are always needed.

4.      How do lasers remove tattoos? How effective are they?

Because of differential color absorption, some tattoos are easier to remove than others. For example, black and blue pigments clear the easiest followed by red and greens. Light colors such as pink, orange, yellow and white are often very resistant.

It usually takes six or more treatments to remove a tattoo or reduce it to a shadow or smear. Complete removal cannot be guaranteed or predicted for any tattoo. There is definitely some discomfort associated with laser tattoo treatments and there is often some blistering that develops after a treatment. There is some risk of scarring due to the loss of skin pigment from the absorbed heat.

5.      Can I get rid of those tiny blood vessels on my nose and cheeks?

The laser wavelengths needed to treat red colors has been known for decades and served as the color basis for the initial introduction of the concept of laser photothermolysis. (treating color-specific targets) Red spots (angiomas) and small superficial blood vessels are ideal for laser treatments.

Angiomas are quick and easy to treat. The laser turns them initially black (coagulated) and the body simply absorbs them away after a few weeks. Telangectasias are different in that they have flow (you only see them because they have blood flow in them)and are located at different levels in the skin. They are more difficult to treat as it is a delicate balance between enough heat to clot the vessel off but not enough to burn the skin and create a scar. If they are not adequately coagulated, the clot breaks down later and they reappear as the flow returns. Facial telangectasias often require more than one treatment to get the best result.

6.      Will laser treatments help scars?

Scars from acne and injury are frequent patient requests for improvements. In some cases, laser treatments can provide scar improvement but it is highly dependent on the type of scar. Laser treatments are frequently given more credit for scar improvements than they often produce.

Deeper laser resurfacing can reduce the appearance of fine superficial acne scars but not deeper ice-pick or saucer-shaped acne scars. More superficial depth laser treatments rarely produce  any improvement. More than one laser treatment is usually needed.

Incisional and traumatic scars can be improved with laser resurfacing but only if the problem is one of irregular texture. Excisional treatments are more frequently used and are more effective for the problems of wide, depressed, or raised scars. Scars that are noticeable because of their persistent red color can be improved with red wavelength laser treatments.

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7.      What’s the difference between laser and light treatments?

While both use light as the treatment method, the type of light used is quite different…which also makes what they are effective for quite different also. A laser is high-energy focused light of a single wavelength. Light, or pulsed light treatments, are lower energy, non-focused light treatments. Known as IPL, BBL, and photofacials, they are very effective for brown spots on the face and hands and generalized redness and rosace. When used with other skin treatments, it can also provide for some minor skin texture improvement and tightening.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon,, Indiana

Indianapolis    

Energy technologies, such as laser and pulsed light, have been a big part of causing the tidal wave of non- to minimally invasive cosmetic treatments available today. When combined with Botox and injectable fillers, a wide range of cosmetic improvements of the skin are possible.

The most common skin problems that I see in my Indianapolis plastic surgery practice that people want treated are facial wrinkles and  telangiectasias and solar lentigines (brown spots)  of the face, body, and extremities. Other less common but not rare skin conditions to see are acne, rosacea, and melasma.

Facial telangiectasias and different forms of angiomas are not the easiest to treat in terms of getting a high elimination rate with one treatment. One has to have a lot of experience with the laser unit that you have to treat these dynamic vascular  problems. While there are many different laser manufacturers with different machines and settings, laser vascular treatments defy consistent results with just one wavelength, power level, depth of penetration, and thermal relaxation time. There is no one magical laser that simply works without experience and knowledge of what its effects are at different settings. While I use the Sciton laser, it has  taken me sometime before I have found a balance of settings that gives consistent results. It is easy to create hot spots or skin burns with an inexperienced treater of vascular lesions.

Solar lentignes or brown spots are the easiest of skin cosmetic problems to treat. Using the BBL pulsed light energy from Sciton, most true solar pigmentation problems can be reduced in one treatment with easy to find settings (joules and milliseconds) that will work. A near immediate darkening of the brown spot is a very favorable sign. It often takes two treatments to get the best reduction and complete elimination does occur in many cases.

There continues to be a high demand for facial skin resurfacing  with the patients demanding a quicker recovery from  the greater depth treatments that we did ten years ago. Patients seem very willing to accept a series of skin resurfacings if their recovery can be days and not weeks. Most skin resurfacing patients have brown spots and telangiectasias and resurfacing wavelengths will not get rid of most of them.  Laser vascular and BBL treatments are usually needed and a question  is whether they should be done at the same time. In many cases they can and the skin resurfacing phase follow the others when they are combined. When properly done, there should be no increased risk of injury or burns with combination laser or light energy therapies. Such an approach eliminates patients coming back for additional treatment sessions and more potential social downtime. When many different treatments are combined, I usually provide some oral sedation for a more comfortable experience.

When possible, one should also try to combine Botox and injectable fillers during the same treatment session as well. Since I use local anesthetic blocks for injecting around the mouth, this is an ideal time to do painless perioral laser resurfacing which often must be deeper than the rest of the face to get a good result.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Laser Tattoo Removal in Indianapolis

The popularity of tattoos in the past two decades has spurned an alternative industry….tattoo removal. According to some studies, approximately 20% to 30% of tattooed individuals will eventually desire their removal. The use of the laser offers a more cosmetically acceptable method than surgery or dermabrasion. When I see patients that are considering laser tattoo removal, laser tattoo treatment would be a more accurate term, I like to emphasize the following principles.

Tattoos are a form of exogenous pigments, historically composed of heavy metal salts and oxides of various colors and dyes. Tattoo pigments, unlike drugs and most cosmetics, are unregulated. The exact composition of tattoo pigments is unknown to either the tattoo artist or the patient. As a result, it is impossible to predict whether any tattoo will respond effectively to laser treatments.

There are two fundamental types of artistic tattoos, professional and amateur. Highly decorative professional tattoos have a variety of pigments and are very difficult to remove, requiring a lot of treatments and complete clearance is rarely achieved. Many times they use colors that are particularly resistant to laser removal including colors such as pink, orange, yellow and lighter greens. Amateur tattoos often use carbon ink as the pigment, are usually one color, and respond fairly well to laser treatments. Some amateur tattoos, however, are placed very deep into the skin, often portions of the tattoo being below the skin surface, and these are impossible to completely clear.

For a patient to consider laser tattoo treatment, they must accept the following:

1) Multiple treatment sessions are always required, anywhere from 4 to 10 treatments per tattoo. It is impossible to predict how many laser sessions may be needed before the first treatment.
2) Complete clearance of most tattoos is not achieved. Lightening, partial clearance, and a residual ‘ghost’ is often the best result for many patients.
3) Patients with darker skin pigmentation are poor candidates for laser tattoo treatments and are at high risk for scarring and hypopigmentation of treated areas.

Lastly, it is important to know that cosmetic tattoos, i.e., permanent makeup such as eyeliners and lip liners, usually contain iron oxide and titanium dioxide compounds These types of tattoos will darken, rather than lighten, with laser treatments.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis