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Your Guide To:
Lasers and Light-based Devices

Resources to help you create your profitable practice more quickly & easily!

Your Guide To:
Lasers and Light-based Devices

Resources to help you create your profitable practice more quickly & easily!

Overview

All lasers work by producing a single wavelength (color) of light. 

In essence, the laser produces a controlled injury to the skin that causes just the right amount of damage to promote new cell growth.

Lasers fall into two categories; ablative and non-ablative. 

A laser works by vaporizing the top layer of the skin to remove blemishes, scars and wrinkles.

  1. Lasers that remove the top layer of the skin are called ablative lasers and include erbium and CO2 lasers. The ablative laser affects only top layers of the skin and allows for healing of superficial problems due to photoaging (sun damage) or chronological aging.
  2. Lasers that are capable of removing tissue beneath the first layer of skin (in the epidermis) are called non-ablative lasers. The non-ablative laser removes skin damage that is much more severe and the recovery time with a non-ablative laser is much swifter than it is when conventional ablative lasers (such as the CO2 and erbium type) are used. It is a sophisticated laser skin rejuvenation procedure. Non-ablative lasers are also called “wounding lasers” as they cause a more extensive and deeper “controlled injury” to the skin.

Figures from the American Society for Aesthetic Plastic Surgery (A.S.A.P.S.) indicate that laser skin resurfacing was among the top 5 most requested cosmetic treatments in the U.S.A. in 2020 with over 997,000 treatments.

The number of treatments quoted by ASAPS included 27.2% carried out with an ablative laser and 72.8% with a non-ablative laser.

Specific Lasers

There are 4 main categories of lasers used in dermatology:
  • Gas Lasers: Carbon dioxide, Argon, Copper vapor etc. These are the first lasers which emit a constant beam of light for longer durations of exposure.
  • Solid State Lasers: Ruby, Nd:YAG, Er:YAG, KTP, Alexandrite etc. These emit interrupted emissions of constant laser energy.
  • Liquid Lasers: Dye lasers. Pulsed dye lasers emit high energy laser lights with very short pulse durations and longer intervals between each pulse.
  • Diode Lasers: Diode lasers have several wavelengths and are suitable for soft tissue procedures.

Aesthetic IPL / Lasers

Lasers and IPL devices are an integral part of an aesthetic practice. These devices can be either a single wavelength or light source machine or be part of a platform device that allows a wide variety of procedures to be successfully performed using a single device. 

Lasers and IPLs are useful for hair removal, wrinkle reduction, acne treatment, vascular treatments, skin resurfacing, tattoo removal and other beauty treatments.

Companies like Cartessa Aesthetics offer many options when deciding which equipment to invest in, and provides a truly consultative sales approach with your practice needs in mind.

According to the 2019 Aesthetic Plastic Surgery National Databank Statistics, hair removal (pulsed light or laser) procedures have increased 52.1% from 2018 to 2019.

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Ablative & Non-Ablative Lasers

Non-Ablative Lasers for Skin Resurfacing

Non-ablative lasers are the newer technology. Instead of removing the top layer of skin tissue, non-ablative lasers work beneath the surface skin layer to improve skin tone and texture and get rid of wrinkles.

During the procedure, a computer is used to control different colors of laser light to correct all kinds of different problems. 

In non ablative laser skin resurfacing:

  1. A yellow pulsed light is used to correct such conditions as red or wine colored birthmarks, enlarged blood vessels, scars from acne rosacea or any reddened area of the face (such as a red nose caused by alcoholism.) It can also be used to treat stretch marks.
  2. A green colored ablative laser light is used to correct scars and marks that have a brownish hue to them such as freckles and age spots.
  3. A ruby red laser is used for tattoo removal, age spots, freckles and for general facial rejuvenation.

Types of Non-Ablative Lasers

  • Fractional Lasers are the latest lasers which produce microscopic treatment zones and target specific depths in the dermis. These are especially useful for the treatment of acne scars, wrinkles, sun damaged skin, etc. Wavelength is in the range of 1550 nm, and the target chromophore is water within the tissue.
  • Diode Lasers: With different wavelengths. The absorbing chromophores are melanin and hemoglobin in the skin. Diode lasers are used for laser hair removal, dilated vein treatments, and laser photo-rejuvenation.
  • Dye Lasers contain organic compounds in solution (often rhodamine) as the active medium and have wavelength activity between 400 to 800 nm. The target chromophores are hemoglobin and melanin pigment. Dye lasers are useful in treating vascular lesions and for non-ablative skin rejuvenation.
  • Excimer Laser containing compounds of xenon, krypton and argon target proteins and water and have wavelengths between 190-350 nm. Excimer lasers are useful in the treatment of psoriasis and vitiligo.
 
Source: Types of Medical Lasers in General Medicine by Hanish 

Source: Types of Medical Lasers in General Medicine by Hanish Babu, https://dermatological-treatments.suite101.com/article.cfm/types_of_medical_lasers#ixzz0p4L0bt8P

Applications of Non Ablative Laser Treatments

The applications of the three types of non-ablative laser skin treatments are effective at:
  • Eliminating fine lines on the upper lip, cheeks, and forehead
  • Smoothing and tightening upper and lower eyelid skin
  • Removing crow’s feet around the eyes
  • Softening frown lines
  • Removing freckles and brown spots
  • Removing age spots
  • Removing tattoos
  • Removing stretch marks
  • Removing burst blood vessels
  • Reducing redness in the skin
  • Flattening scars
  • Repairing smoker’s lines
  • Smoothing and polishing the complexion in general for a more youthful appearance

The Benefits of Non Ablative Lasers

The benefits of non ablative laser skin surgery are reduced healing time, less risk of infection and less time spent in the doctor’s office. 

The procedure is done on an outpatient basis and can take anywhere from two minutes to two hours to complete.

If you are light skinned then non ablative laser skincare will work for you. 

If you have dark skin then ablative erbium laser resurfacing might be preferable as it is less likely to cause hypopigmentation (lightening of the skin).

Another use of the non-ablative laser is for long lasting permanent hair removal. 

This is because the laser is able to reach below the first layer of skin and kill the root of the hair in the hair follicle.

The only drawback of non-ablative hair removal is that it does not work with light hair on light skin and it cause depigmentation in dark skin. 

It works best on people who have dark hair on white skin.

Non Ablative Recommendations

As the non-ablative technology is newer technology it is not always offered by all plastic surgeons.

If your plastic surgeon does not offer non-ablative laser treatments it may be simply because he does not own the equipment or have the training.

Laser and skin surgery centers are numerous, so it is recommended that you consult with the American Society of Plastic Surgeons in order to find a plastic surgeon that is trained in non-ablative laser surgery that is located nearest you.

Source:  https://www.plasticsurgeryadvisor.com/skin-resurfacing-surgery/non-ablative-laser-surgery.shtml

Ablative Lasers for Skin Resurfacing

Ablative lasers briefly direct an intense burst of laser energy onto the surface of the skin.

This energy heats water within the surface layers of the skin, causing both the water and the tissue of the skin to turn to vapor.

Every time the laser passes over the skin, some of the outermost layers of the skin are removed in a precise and controlled way to the appropriate depth.

The skin then heals over a period of time, as new layers of collagen are produced.

The skin can literally resurface itself, causing an improvement in the appearance of sun damaged or acne scarred skin.

The skin then heals over a period of time, as new layers of collagen are produced.

The skin can literally resurface itself, causing an improvement in the appearance of sun damaged or acne scarred skin.

After the treatment, the skin will look much healthier than it did previously.

This intensive treatment can significantly reduce the appearance of lines, wrinkles, and pigment (or skin color) changes on the face, neck, and other parts of the body.

They can be used in sensitive areas, such as lines around the lips, eyes and even eyelids, or over the whole of the face.

Acne and other types of scars and certain stretch marks can also be improved.

There are two main types of ablative laser – the original machines used were carbon dioxide lasers, and more recently erbium: YAG laser systems have been introduced.

Source: https://www.consultingroom.com/Treatment_FAQs/Display.asp?Treatment_Faqs_ID=43&Treatment_Name=Laser%20Skin%20Resurfacing

Types of Ablative Lasers

  • CO2 Lasers: The laser light from these lasers are absorbed by water in the skin, hence, used for skin resurfacing, removal of benign skin tumors like warts, xanthelasma, mucous cysts, cherry angiomas, leukoplakia and for surgical cutting.
  • Nd:YAG Lasers: The active medium is Neodymium in yttrium-aluminum-garnet and the wavelength is 1064 nm. NdYAG lasers have slight absorption in melanin and hemoglobin and are used for laser hair removal, laser vein treatments, laser photo rejuvenation, laser acne treatments and in laser skin surgeries.
  • Q Switched NdYAG Lasers have strong absorption in dark tattoo inks, hence used in laser tattoo removal.
  • >Er: YAG Lasers have a wavelength of 2940nm and the active medium is Erbium in yttrium-aluminum-garnet. It is absorbed by water in the skin and is used for skin resurfacing, laser photo-rejuvenation and for removal of skin growths.
  • Ruby lasers have a wavelength of 694 nm and contain Chromium ions in aluminum oxide as the medium. Ruby laser light has very strong absorption in melanin and black and dark blue ink pigments. These are especially useful in tattoo removal. Laser hair removal and removal of pigmented (dark) skin lesions.
  • KTP or Potassium Titanyl Phosphate Laser with 532 nm wavelength is a frequency doubled NdYAG laser with absorption by hemoglobin and melanin and used to remove vascular and pigmented skin lesions.
  • Alexandrite Lasers: 755 nm, Q switched mode laser, used to remove blue, black and green tattoos and epidermal and dermal pigmentations.

Overview of the Use of Lasers for Hair Removal

Temporary hair removal is accomplished with conventional treatments such as shaving, waxing and epilation. 

Another method is the use of selective photolysis, which is light energy that is produced by the laser, and is targeted at the pigment in hair. 

This causes destruction of hair follicles while sparing surrounding structures (i.e., the skin).

Long lasting hair removal can be achieved with the use of several available lasers. 

Total temporary hair removal, which lasts for several months, can be done in almost all patients. 

However, total permanent laser hair removal is not commonly done. 

Stable permanent hair removal may be possible in some cases and usually requires multiple treatment sessions.

It is important to note that the FDA and medical associations make a clear distinction between permanent and complete hair loss or removal. 

Complete hair loss refers to a lack of regrowing hairs (ie, a significant reduction in the number of regrowing hairs to zero). Complete hair loss may be either temporary or permanent. 

Laser treatment usually produces complete but temporary hair loss for 1-3 months, followed by partial but permanent hair loss. 

Histological observations show damage predominantly in hair follicles with large, pigmented shafts, while hair follicles with small (<25 mm), hypopigmented shafts do not demonstrate any morphological change.

Lasers Used in Hair Removal

Ruby Laser (694 nm, normal mode)

  • All patients will see a growth delay of their hair. Some patients will see a permanent reduction in hair growth.
  • This laser is more effective for dark hair. Blonde and gray hairs are more resistant.
  • White hairs do not respond to treatment
  • Epilaser® (Palomar) and Epitouch® (Sharplan) are examples of ruby lasers

Alexandrite Laser (755 nm, normal mode)

  • All patients will see a growth delay of their hair. Some will see a permanent reduction in hair growth.
  • It is effective for dark hair. Blonde and gray hairs are more resistant.
  • White hairs do not respond to treatment
  • It is potentially safer for darker skin than the ruby laser
  • Rapid repetition rates of the laser will reduce treatment time
  • Apogee® (Cynosure) uses a cooling gel on the skin
  • Gentlase® (Candela) uses dynamic cooling spray

Pulsed Diode Laser (800nm)

  • Patients with thick or coarse hair will see a delay in hair growth. Some patients will see a permanent reduction in hair growth.
  • It is effective for dark hair. It is not effective for fine hair.
  • Potentially, it is safer for darker skin types
  • LightSheer® (Coherent) uses contact cooling

Intense Pulsed Light Source (500-1200 nm)

  • It is effective for dark hair, both fine and coarse
  • It is potentially useful for darker skin types
  • Epilight® (ESC) uses cooling gel

Nd:YAG Laser (1064 nm, Q-switched)

  • Permanent hair removal has not been demonstrated
  • It can temporarily remove light hairs
  • It is potentially safe for all skin types, and causes the least epidermal damage of all treatments.
  • Carbon suspension is applied to skin in some treatments
  • There is a lower risk of epidermal damage
  • Short operative times are required
  • It causes the least discomfort of all laser hair removal treatments
Source:  https://www.skincareguide.ca/treatments/laser_hair_removal.htm

Costs

Patients should expect laser skin resurfacing to cost between $2000 to $3000 US.  

According to the American Society of Plastic Surgeons, the national average cost for laser skin resurfacing is $2,378.

The cost of laser skin resurfacing will involve several factors.

The laser skin resurfacing cost that is initially quoted tends to be the surgeon’s fee, but the patient will likely have to pay facility costs as well. 

The procedure may be performed in a surgeon’s office, an outpatient surgical facility, or a hospital. 

Hospitals are the most expensive places to undergo the laser skin resurfacing procedure, but they are also the safest and may be the best choice if you are undergoing another surgical procedure in conjunction with the laser procedure or are undergoing a particularly extensive or complicated treatment. 

The surgeon’s fee itself will be larger if you are undergoing a complicated procedure or treating a larger area of the skin.

During the procedure you will need to be placed under either local or general anesthesia and that will be part of the total laser skin resurfacing price. 

General anesthesia can be expensive, but many people wish to save themselves discomfort and anxiety by sleeping through the procedure. 

Patients should also factor pre- and post-operative care costs into their economic calculations, as well as the expense of post-treatment pain medication. 

Swelling and tenderness are commonly experienced side effects during the laser skin resurfacing recovery period. 

Another revenue stream for physicians may be special makeup to camouflage the redness of the treated area that may persist for several months following treatment.

Source: https://www.docshop.com/education/dermatology/facial/skin-resurfacing/cost-financing/

Costs for Patients for Hair Removal Treatments

The typical cost of laser hair removal is $150 to $500, depending on the area of the body that is being treated. 

In most cases, the smaller the surface area to be treated, the lower the treatment cost.

According to the American Society of Plastic Surgeons, the average price of laser treatments in the United States is $429.

  1. The cost of laser hair removal in the smaller, bikini area is between $350 and $500.
  2. The cost of treating a larger area, such as the back, averages between $600 and $900 per treatment session.
  3. However, treatment of the chest will only cost between $350 and $600.
  4. For the upper and lower legs, patients can expect to pay from $600 to $850.
  5. The arms, on average, will cost only $350 to $500.
  6. The underarms are the cheapest area to treat, with a cost range of $250 to $350.
  7. Removing hair on the face and neck is comparable to the cost of laser hair removal on the back, with prices averaging $600 to $900 per treatment.

Other Uses of Lasers: Hair Growth, etc.

Ironically, one of the newest applications for lasers in aesthetic medicine is in hair regrowth.  

Low level laser therapy (LLLT) also known as laser biostimulation, photobiomodulation and cold laser therapy is now used for the treatment of hair regrowth.

It is believed that LLLT may increase blood flow to a treated area as well. European studies have shown that LLLT stops hair loss in 85% of cases and stimulates new hair growth in 55% of cases. 

In January of 2007 a hand-held laser therapy device was cleared by the FDA as a treatment for ‘androgenetic alopecia’ (male pattern hair loss). 

Low Level Lasers have been approved in this country as a treatment for carpal tunnel syndrome, as a wound-healing aide, and as an adjunct to liposuction procedures. 

Laser therapy has been safely used for decades throughout Europe, the Far East and has no documented side effects.

Source:  https://www.baumanmedical.com/Default.aspx?tabid=52

IAPAM Demystifies Cosmetic Laser Treatments

The IAPAM’s Aesthetic Medicine Symposiums represent the most comprehensive, minimally invasive modality, and laser treatment training for physicians new to the aesthetic medicine field.  

The IAPAM’s multi-day Aesthetic Medicine Symposium program focuses on the top 5 minimally-invasive treatments:  botox, dermal fillers, medical microdermabrasion, chemical peels, laser treatments and light procedures.

The IAPAM focuses on training physicians and their medical staff in the best practices for device-based aesthetic medicine treatments using laser treatments, light sources and radiofrequency devices.  

Part of the IAPAM training is to educate physicians on both best practices and possible complications, including:

  • 78% of complications occurred in non-traditional medical facilities, such as freestanding medical spas and laser centers in shopping malls;
  • 46% of complications occurred with hair reduction;
  • 21% of complications occurred with Laser/Light leg vein treatments; and
  • 42% of complications were permanent.

Part of the IAPAM’s training includes overviews of current clinical research.

In a recent study by Vic A. Narurkar, M.D et al, it was reported that, “eighty two percent of all complications [with device-based procedures using lasers etc.] occurred in facilities that had no direct physician supervision. 

Of these, 57% were in facilities with a “medical director” who had limited training in dermatologic procedures and laser/light-based therapy. 

Of all the complications, 78% occurred in non-traditional medical facilities, such as free-standing medical spas and laser centers in shopping malls.

Does Adding Laser Tattoo Removal Training in Your Clinical Practice Make Sense?

Tattoo removal has become a rather popular cosmetic procedure in the last few years. 

Patients who decided either on a whim or as an informed choice to have a tattoo realize later in life that they do not wish to have it on them anymore. 

More and more people are now seeking tattoo removal at a practice close to them, and a study published in the Journal of American Medical Association Dermatology concluded that ‘poor decision making and subsequent personal regret’ seemed to be the main motivating reasons to seek tattoo removal treatments.1 

If you have not included this service in the service you provide, then you could be missing out on both a large patient base and also a good source of income. Laser tattoo removal training is an easy add-on to a physicians practice.

But before going into the reasons why you should add tattoo removal to your practice, let’s take a brief look as to how tattoo removal works.

Tattoo Removal – The Process

Tattoos are relatively permanent ink designs that are etched through until the dermal layer of the skin. They are available in just dark ink, though tattoos can be fairly colourful as well. 

While the technology was tattoo removal has advanced a fair bit in the recent years, it still remains a fact that certain tattoos cannot be removed completely. 

A number of different factors come into play, such as the size of the tattoo, the location, the type of ink and the duration it has been there.

There is a number of different ways tattoos can be removed. Procedures range from dermabrasion, cryotherapy, CO2 laser, and alexandrite laser. Surgical excision of tattoos with subsequent skin grafts has also been performed. 

Laser therapy remains the gold standard treatment option when it comes to tattoo removal, and lasers such as Q-switched Ruby, Alexandrite and Nd: YAG laser are often utilized. The laser is directed at the pigmented skin tissue, and this subsequently shatters the pigment into smaller particles that are then absorbed by the blood stream, targeted by the immune system and removed.

Why patients are choosing this treatment

A survey conducted in 4 states in the United States revealed that the average age for getting a tattoo is 20 years, which no doubt is quite a young age. 

Once education is complete and life takes the path of a career, certain professional requirements require different types of clothing to be worn which can cause problems if the tattoos are not covered up. In addition, negative comments from clients and colleagues may also be a reason.

More and more patients are now aware of laser treatments that can be undergone for tattoo removal. Most of these patients are women between the ages of 24 – 39 years who are often single, college educated and in stable family relationships. 

Interestingly, statistics also show that most tattoo removal is sought after by White or Hispanic individuals who are keen to dissociate themselves from their past.2

Why "Grow" your practice by adding tattoo removal?

a. Overwhelming statistics

If one were to look at the statistics in the US, over 45 million Americans currently have at least one tattoo. 2 Of this group, 36% of the range between the ages of 18-25 years, while around 49% are between 26 -40 years. A large majority of the population has black ink tattoos, and 70% of the total population who have tattoos are women.

It is clear that the potential patient population is huge. It can also be inferred from this statistic that as the number of tattoos increases, so will the need for laser tattoo removal training. In fact, 17% of the above population group regret ever getting a tattoo – this amounts to over 7.6 million people.

b. Enlarging patient base

If you are looking to expand your practice and have more patients attend your clinic, then adding tattoo removal to your service is definitely the way forward. The numbers are clear from the previously discussed statistics, and the potential to increase your patient base is big.

c. Increased income

The average tattoo removal cost is $200, and each procedure takes around 15 minutes to perform. If you were to perform 3 – 4 procedures an hour, that could mean an additional $800 a day. The income stream just does not end there. Patients often need 6 to 7 sittings of treatments, making the average income per patient around $1200 to $1400. Some centers that have already started offering this procedure are seeing an increase in monthly income of around $20,000.

Utilizing the right equipment

Once you have made the right choice on a laser tattoo removal training program, it is essential that you have the very best in equipment that is currently available on the market. It is important to keep in mind that this initial investment is what will decide the future income, so it is important to get it right the first time.

The Q-Plus-C is the only true three wavelength QS system on the market. Extensive literature reviews published have demonstrated that QS lasers can removal a multitude of tattoos safely and effectively.3

With the right equipment and right advertising, your initial investment will be comfortably paid off fairly quickly. The overall ROI can be tremendously high as well, particularly because this is a sought-after procedure.

Conclusion

Tattoo removal is becoming a popular procedure among the large population who have had tattoos a number of years ago. The evidence backing the procedure is good, and the return on investment can be excellent. In addition, the service that you provide will be one that your patients will be grateful for. 

Utilizing the right equipment like the ones supplied by Quanta can offer your patients the safe and effective treatment they are looking for.

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1. Armstrong, M. L., Stuppy, D. J., Gabriel, D. C., & Anderson, R. (1996). Motivation for tattoo removal. JAMA Dermatology, 132(4), 412.

2. ‘Tattoo Removal: New Laser Options’ Journal of Drugs in Dermatology 2013:12(4) Retrieved from https://jddonline.com/articles/dermatology/S1545961613P0492X

3. Kent, K. M., & Graber, E. M. (2012). Laser tattoo removal: a review. Dermatologic Surgery, 38(1), 1-13.

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Emerging Trends, Expert Discussions, Recommendations, Technique Comparions​

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