Laser Treatment

Skin Pigmentation Treatments – Do Lasers Provide Permanent Results?

Thinning, along with elasticity reduction are just some of the problems our skin faces over time. These problems alarmingly speed up due to increased contact with the harmful rays of the sun.

To visualize the effect of skin aging that resulted from overexposure from the sun, we can compare the look of the skin that has none or less exposure from the sun such as the skin under the chin or the upper forearm’s inside skin to the skin that is frequently subjected to sun’s rays which include the back of our hands and the face.

The skin exposed on high UV rays would normally have the following issues: alteration in texture such as wrinkles (rhytids), sunspots (solar lentigines), freckles (darkened ephelides), roughness, yellow-brown discolouration, redness, fragility, sagging and may develop certain types of skin cancers.

One of the more accessible skin pigmentation treatments is laser surgery

The capability of lasers to cure various skin conditions comes from their two fundamental properties. One is their capacity to create a strong, focused light beam that can precisely dismantle the skin tissue being exposed. Second is their ability to focus on an exact target which is determined by the colour and other features of the target tissue. This capability to target tissues of specific colour exceptionally lessens damage to neighbouring tissues whose colour is different from that of the intended tissue. There are a lot of myths in Singapore surrounding pigmentation treatments with lasers as Dr David Ng Cheow Hua from One Face Clinic points out. I suggest you read his article on the subject after you’re done with this one. If you’re having skin pigmentation problems, I highly suggest you schedule a consultation with him in his clinic at 1 Tras Link, #02-01 Orchid Hotel. And without any further delay, let’s get into the different types of laser treatments and what they do.

Laser Treatment for Skin Pigmentation

Q-switched Nd: YAG and ruby lasers are the most common lasers applied to cure skin pigmentation. The aesthetic result is mostly good in many procedures, but one of the main factors for good results is the skill of the doctor using it. One to three procedures are needed for a successful treatment. Aside from laser treatment, there are other choices open for patients. The application of bleaching agents before and after treatment would also be beneficial.

Laser Principles

laser freckle skin removal

Creating a monochromatic, accurately parallel, intensely concentrated beam, laser devices form a single wavelength with collimated rays that slightly disperse. Photothermolysis is the principle behind the treatment using lasers of pigmented skin damage.

There are two major laser classifications that are applied to pigmented skin damage. The first one is pigment specific lasers that focus on melanin chromophore in skin pigmentation damage. The other one is skin resurfacing lasers that focus on the dermal tissue’s water chromophore.

Directing to skin pigmentation, the light of a particular wavelength is selectively absorbed following the laser concept; the injured skin is carefully heated, treated and removed while the neighbouring skin is unaltered.

As the energy of the laser is absorbed by the skin, the beam can undergo four different processes. These include absorption, reflection, transmission, and scattering. All four processes happen to a certain degree. However, the absorption process is the most significant in clinical procedures.

The light-absorbing compounds in the skin called chromophores control and determine the amount of laser energy that is absorbed. The parameters of the laser treatment ensure that the target chromophore of the unwanted skin pigmentation has the highest amount of laser energy absorption than the chromophores of the neighbouring skin tissues.

Components of a Laser

The lasing medium is the most important part of the laser. When triggered by an external energy source, the lasing medium releases a specific wavelength of light. Through an internal procedure of stimulated emission, the lasing medium has capabilities that permit it to intensify the light.

Bordering the lasing medium, an optical cavity in lasers holds the amplification process. To supply energy to the lasing medium, a power “pump” is also added. The energy is precisely transferred to the skin through a delivery system which includes an articulated arm containing mirrors or a fibre optic cable.

Laser Devices Overview by Type of Technology

In terms of the type of technology applied, lasers are composed of two major classifications which are ablative devices and nonablative devices. Ablative devices treat the skin using both heat and vaporization while nonablative devices use only heat and do not employ vaporization or tissue removal.

Ablative devices focus on water as the main chromophore. They are mostly applied for skin resurfacing that will result in wrinkle reduction and pigmented lesion lightening. In contrast, nonablative devices have the ability to target a wide selection of chromophores. For nonablative skin resurfacing, nonablative devices are specifically applied to target water and lead to wrinkle reduction. Other types of nonablative devices have the ability to target oxyhemoglobin, melanin, and tattoo ink, depending on the type of skin treatment needed.

Pigmented Lesions

Sunspots or freckles, which are types of benign pigmented lesions, are treated using lasers through selectively targeting melanin or through targeting water and non-selectively eliminating pigmentation using skin resurfacing.

By vaporizing melanin, ablative lasers selectively remove the pigmented lesions in the skin tissue. To eliminate pigmented lesions, nonablative lasers extrude melanin from MTZs together with other skin debris.

When medicating skin pigmentation damage using lasers, the doctor should assure that it is not malignant. In effect, neoplasias are not suggested to be performed using cosmetic laser surgery. It was studied that one of the major contributing factors to the development of pigmented basal cell carcinomas and melanomas which are examples of neoplastic pigmented lesions is chronic sun exposure.

Sun Exposure

Poikiloderma of Civatte, postinflammatory hyperpigmentation (PIH), and melasma are some of the dyschromic conditions that are linked with or aggravated by extreme exposure to sunlight. In addition, freckles, sun spots, and mottled pigmentation are the most typical non-malignant skin pigmentation lesions linked with skin ageing due to sun exposure.

Advantages of Laser Treatment for Pigmented Lesions

  • In contrast to liquid nitrogen, it has less risk of hypopigmentation.
  • Lesser recovery time and lesser risks of secondary conditions which includes scarring, hyperpigmentation, hypopigmentation, or infections
  • In comparison to using retinoids or hydroquinone, it gives a more perceptible improvement in a fairly short period during recovery.

Disadvantages of Laser Treatment for Pigmented Lesions

  • Compared to non-laser treatments, it has a greater cost on equipment investment.
  • Poses a higher risk of scarring, hyperpigmentation, and hypopigmentation to those who have a darker Fitzpatrick skin type (IV and above)

Results

Although various factors affect the results of treatment of benign pigmented lesions, patients with light Fitzpatrick skin types that have sunspots and freckles experience the most significant improvements. Their effective treatment can also be observed with the least number of treatment sessions. However, the treatment of slightly coloured skin lesions including Poikiloderma of Civatte, melasma, PIH is harder to treat and poses a bigger challenge.