We’ve all heard about the many uses of lasers in medicine. Lasers are used in surgery to destroy cancerous and precancerous tissue, to remove tissues such as tonsils with much less pain and swelling than with conventional surgery, and to remove tumors which contain many blood vessels that otherwise might be difficult or dangerous to remove.
Earlier lasers such as the C02 and Argon Lasers were also used to treat certain skin conditions such as birthmarks, tattoos, and warts. These earlier lasers had the disadvantage of leaving more scars after the treatment of certain skin lesions especially if the tissue to be removed extended deeper into the skin, as in many tattoos. The patients generally preferred the scar to the tattoo; however, since the scar had less social stigma than the tattoo. As a plastic surgeon in the military, I had abundant experience removing tattoos with these early lasers, but I was not satisfied with the scars that resulted.
Fortunately technology came to the rescue. A second generation of lasers was developed for treatment of these superficial skin lesions. Depending on the color and depth of the skin lesion, we are now able to select from a number of lasers that differ in the wavelength of light that the laser produces. When the laser light hits the brown or red skin discoloration or tattoo pigment, it is selectively absorbed. The rapid absorption of the light energy causes the tattoo ink or the pigmented cells in the skin brown spot to destruct or burst apart. The body’s natural filtering system then removes the debris. Because the surrounding normal tissue does not absorb the laser energy, the treated area is less likely to scar.
Superficial skin spots such as brown age spots, "liver spots", and freckles are usually removed with one to two treatments. Common areas that develop brown spots are the sun exposed areas of the face and back of the hands. Occasionally after laser treatments, some brown birthmarks may return after several months to a year. Elevated brown spots such as moles or lesions that may be cancerous should not be treated with the laser, but should be removed surgically so that they may be sent to a pathologist for a definitive diagnosis, as further treatment may be needed.
Red skin spots and superficial blood vessels especially on the face may be treated with the laser, which is selectively absorbed by the red blood cell hemoglobin. The overlying skin is usually left undamaged, but the superficial vessels and/or spots are destroyed. Small spider veins of the legs may be treated with the laser but generally respond better to other treatment methods, such as injection of sclerosing solutions.
The most exciting use of the new lasers are in the treatment of tattoos. Decorative tattoos have been in vogue for at least 5,000 years and a multitude of tattoo removal techniques have been used throughout history including sanding of the skin, chemical treatment of the skin, and laser removal of the skin containing the tattoo. All treatments lead to the same problem; a scar similar to a burn scar, since most tattoos extend deeper into the skin. With the advent of this new generation of lasers that selectively send energy only into the tattoo pigment, we have seen a marked decrease in the scarring. Tattoos are either professional, where a large amount of pigment is placed using a tattoo machine, or non-professional where a small amount of pigment is placed usually using a needle. Non-professional tattoos require fewer laser treatments than professional tattoos as they have less pigment to be destroyed. On the average, non-professional tattoos required three to four treatments and professional tattoos require six to eight treatments. Usually the treatments are spaced at one to two month intervals to allow the body’s filtering mechanisms to clear out the tattoo pigment debris. Not all colors respond equally well with all lasers, but fortunately several different types of lasers are available so that most pigments will respond to one of the available lasers.
Laser treatment is usually performed in the office, requires no anesthesia, and takes only ten to twenty minutes. The impact of the laser light hitting the skin produces a sensation similar to the snap of a thin rubber band. After treatment the area will feel similar to a mild sunburn.
For treatment of brown spots the area remains reddened for two to four weeks then gradually returns to its normal coloring and texture. For red skin spots, the area typically bruises, but does not leave an open wound. For tattoos which are deeper, there may be pinpoint bleeding and an antibacterial ointment and dressing is applied to the area. A small amount of lighter discoloration and texture change is evident, which gradually improves over time. Permanent scarring is rare.
Laser treatments are usually less expensive than conventional surgery. Costs range from $300 - $600 per treatment session and are usually dependent on the amount of time the laser is in use and on the type of laser used. Insurance usually does not cover the cost of laser surgery for tattoo removal, but may cover the removal of other skin lesions depending on the particular policy.
So the next time you have to cover up those brown discolorations with make-up or conceal that tattoo that you got in your twenties, think about taking advantage of this latest development of laser technology to create healthier and more attractive skin.