The term laser is as common as almost anything in our lives. But what is a laser? First, it is an acronym, standing for Light Amplification by Stimulated Emission of Radiation. And that name is a great start in defining a laser. Essentially, a laser is a device that produces amplified light by using stimulated emission of radiation.
Now before the term radiation scares you, it’s referring to radiation in the broadest way, which is any electromagnetic wave, not the radiation we associate with bodily harm. In a laser, electricity or another form of energy is deposited into a medium, such as crystal. The atoms in the medium are stimulated to emit radiation, often in the form of infrared, visible, or ultraviolet waves. Those waves are concentrated to produce an amplified light beam.
Unlike a flashlight, a laser beam has three particular characteristics: (1) monochromatic, or made of exactly the same color or wavelength, (2) collimated, or focused in one direction, and (3) coherent, or having synchronized waves.
The applications of lasers are ubiquitous, such as cutting (laser cutter), communications (barcode scanner, fiber optics), and defense (laser-guided weaponry). Of course, lasers are also used in medicine. In aesthetic medicine, they are commonly used to remove skin lesions or hair. They can also be used to promote collagen growth.
For example, the laser we use at our practice is the MOTUS. It produces an Alexandrite laser beam with a wavelength of 755 nm, so these waves are a little longer than red light at 620-750 nm, hence “infrared.” Think of it as a concentrated beam of dark red light. The wonderful part is that melanin, or the pigment in our skin and hair, likes to absorb this wavelength. In hair removal, most of the energy in the laser beam is absorbed by the hair and surrounding follicle, which essentially destroys that unit from producing any more hair. Only follicles in a certain stage of maturation are susceptible to this process, so multiple treatments are necessary. The same principle applies to a mole. The cells holding the melanin absorb the energy from the beam and are subsequently destroyed.
The MOTUS also produces a Nd:YAG laser beam at a wavelength of 1064 nm, which is also infrared. At this particular wavelength, the energy is absorbed by hemoglobin more than melanin, so it useful for unsightly blood vessels. In addition, the beam has better skin penetration and delivers thermal energy to the dermis while bypassing the epidermis. In other words, the surface of the skin is spared with no downtime, while the connective tissue underneath is heated to stimulate collagen production, hence the name photorejuvenation or laser collagenesis.
These are just a few examples of laser applications in aesthetic medicine. New lasers as well as new protocols are constantly being developed and it is our responsibility as physicians to stay current in this ever-expanding field, so that we can deliver the best results safely.
When I first heard about microneedling early in my medical career, I was a bit skeptical. It seemed counterintuitive—to purposefully puncture or injure your skin to improve it. Wouldn’t you want to protect your skin from such a thing?
Many years and multiple experiences later, I am a convert. I have witnessed the tremendous effects of microneedling in myself and others. This is backed by scientific literature, supporting its use in treating wrinkles, scars, hair loss (alopecia), stretch marks (striae), photodamage, and other concerns, as well as improving overall skin texture and quality.
The procedure dates back more than 20 years ago to 1995, when Dr. Norman Orentreich (the father of modern hair transplantation) and Dr. David Orentreich used hypodermic needles to treat scars, which they coined “subcision.” Around that time, Dr. Camirand was beginning to use tattoo guns without ink to treat scars. Flash forward to 2006 and the first prototype of the Dermaroller was invented by Dr. Fernandes.
Microneedling starts a cascade of positive effects with puncturing of the skin. It “tricks” the skin into repairing these very minute punctures. It essentially harnesses the healing power of the skin and is in that way a very natural process. Specifically, it increases epidermal thickness and density, collagen production, glycosaminoglycan enrichment, and fibronectin expression. The micro-punctures also allow medications or serums to be delivered more efficiently.
Devices come in various shapes and sizes, such as a handheld pens or rollers, to more precise systems like the Vivace. Needles have varying diameters and lengths. Some are even designed for aestheticians to deliver, although in California, aesthetician delivery is prohibited.
While microneedling is traditionally considered uncomfortable, requiring pre-application of numbing cream to the skin, it has come a long way. Now there are devices that can deliver the needling with very little discomfort. I have even done it on my face without any numbing cream!
In terms of recovery, there is very little down time when done properly or with the right device. Clients may notice mild skin irritation such as redness, dryness, or mild swelling for one to three days following the procedure. Clients may appear like they have a mild sunburn.
The future is combining microneedling with other techniques. For example, we know that platelet-rich plasma (PRP), which is derived from a client’s own blood, is full of powerful growth factors. When punctures from microneedling are created, and then PRP is applied, the skin effect is significantly augmented. This is also true for radiofrequency microneedling, where a small dose of radiofrequency energy warms up the skin, triggering collagen formation.
When I hear about microneedling now, instead of skepticism, I am full of excitement– about how it can help clients look and feel their best, and its growing role in one of many nonsurgical techniques used in aesthetic medicine.