Laser Education Center

The Laser Education Center is provided to Cary Skin Center web site visitors as part of our commitment to patient education. Individuals considering laser surgery should have a basic understanding of lasers, their application in medicine, and the skill and experience of the surgeon who performs your procedure.

History of Lasers
The concept for the development of lasers originated with Albert Einstein in 1917. However, it was not until the late 1950's or early 1960's that lasers were developed. The first application of a laser in medicine was performed by a dermatologist named Leon Goldman, M.D. Dr. Goldman used a ruby laser to treat a tattoo. The first laser used for medical purposes was the ruby laser.

Since this time multiple lasers have been developed. In the 1960's the continuous wave CO2 laser was developed which functions as an instrument for cutting tissue. A modification of this initial technology occurred in the early 1990's and has revolutionized the use of CO2 lasers in medicine.

Following the development of the continuous wave CO2 laser came the Argon laser system. These lasers were used for treatment of birthmarks and tattoos. Unfortunately, the non-selectivity of Argon lasers resulted in significant problems with scarring.

In the early 1980's John Parrish, M.D. and Rox Anderson, M.D. formulated the concept of selective photothermolysis. This concept states that the risk of scarring and damage to normal tissue can be minimized by the use of a laser system, which selectively reacts with a single target within the skin. This led to the development of the tunable dye laser used to treat port wine stains, which are red birthmarks that often occur on the face. Many of these unsightly birthmarks can be removed using lasers, which selectively target hemoglobin within red blood cells. The red blood cells are contained in very tiny blood vessels that make up the port wine stain. A new class of solid state vascular lasers have been developed which more effectively and efficiently treat port wine stains, red blood vessels involving the face and legs.

This concept of selective photothermolysis has been advanced further using different laser systems to target the brown color found in age spots and brown birthmarks in the skin.

The older CO2 lasers have now been modified to allow greater control of depth of penetration into the skin, thereby, improving their safety margin for procedures treating photo-aged skin and acne scars.

Future technologies hope to be able to affect deeper structures in the skin without disrupting the outermost layer of the skin.

Laser Applications In Industry and Medicine
The number and types of lasers has continued to increase and the application of lasers has continued to expand. At this time, lasers are used in industry such as the auto industry to assist in welding and cutting of metals; military applications include the use of lasers as weapons, guidance systems, and communication systems. Lasers in the entertainment industry are used in a wide variety of applications such as laser light shows and the reading of CD discs in CD players. Lasers are playing an increasing role in science and technology such as micro surgical procedures to cut chromosomes or DNA. Lastly, advances in the use of lasers have revolutionized numerous fields of medicine. These include:

• Dermatologic Surgery
• Ophthalmology
• Refractive Surgery
• Cataract Surgery
• Gynecology
• Otolaryngology

What Is A LASER?
The term laser stands for Light Amplification by Stimulated Emission of Radiation.

Lasers are instruments, which produce an intense beam of bright light. This light may be visible such as colors of the rainbow or invisible similar to microwaves and radio waves. The light generated from the laser is of a single wavelength and, hence, each wave of light is identical. This is different from white light or incandescent light in which many different wavelengths of invisible light are generated. The light generated from a laser moves in the same direction with each wave marching in step with its neighboring light waves. These unified features of laser light harness light energy, which can then be used in science, medicine, industry, and communications.

Modern lasers are essentially all the same in that the material used to generate the laser light is contained within a box. Power is pumped into the box to excite the electrons contained in the substance, which will generate the laser light. As these electrons are excited to higher energies they will ultimately drop back to their original energy and give off a photon or light wave. This photon interacts with another excited electron, which then generates two identical wavelengths of light. These two interact with two additional excited electrons and generate four identical wavelengths of light. This chain reaction continues and the light waves pass out of the box by opening a shutter on one end of the box. This light can then be directed to its target site and cause some type of change in that target.

Some lasers produce light which can be seen, whereas other lasers produce light which is invisible. Lasers which produce visible light are used to treat skin lesions which are colored. For example, red birthmarks are treated by yellow light lasers or green light lasers. On the other hand, the green or black ink from a tattoo is treated using red light lasers.

Lasers which produce invisible light use water as their target. Water contained in tissues absorbs this invisible light and causes the change we observe.

What Are The Benefits Of Laser Surgery?
Lasers offer the following benefits:

• Precisely controlled surgery which minimizes damage to normal skin
• Advanced therapy specifically targeted to your condition
• Safe and effective outpatient surgery for many skin conditions
• Reduced risk of scarring compared to earlier non-laser treatments
• Improved therapeutic results
• An alternative to traditional surgical methods in some cases
• Relatively "bloodless" surgery with some lasers

What Type Of Laser Should Be Used?
There are many different types of lasers. At times this causes confusion to physicians and patients alike, who may wonder which laser should be used for a specific condition. One laser is not capable of treating all skin conditions, and some lasers have only a very narrow use in dermatologic surgery. On the other hand, some lasers can treat multiple skin conditions. Dr. Clark and Dr. Flynn will carefully evaluate your particular problem and suggest the appropriate type of laser(s) that might be appropriate for therapy. Test areas are often performed to determine which laser produces the best response.

Improved technology has resulted in the production of a number of different types of lasers. Due to the different types of lasers on the market, it has become increasingly difficult for individuals as well as doctors to know which laser systems are indicated for treatment of a given condition.

It is therefore important to select a laser surgery practice dedicated to the latest technology and knowledge regarding the use of various lasers. The Aesthetic Laser Center at Cary Skin Center meets each of these expectations and qualifications.

When treating port wine stains (red birthmarks), red blood vessels on the face from photo-damage, we recommend the use of the VersaPulse vascular laser. This laser has proven itself superior to other modalities in terms of minimal discomfort to the patient during treatment, rapid recovery and return to normal daily activities, and importantly, removal of the intended vascular lesion.

Are Lasers Safe?
Lasers are machines which generate high intensity, bright light beams. Lasers used in dermatologic surgery are designed to interact with and destroy or disrupt skin lesions. As a result, it is important that the light beam be directed only at its intended target and the laser be used by an individual who is trained in its appropriate use.

Of major importance when lasers are being used is protection of the eyes. This can be performed by covering the eyes during treatment or using protective goggles or glasses that prevent laser light from contacting the eyes.

Even though laser light is a type of radiation it is not like of x-rays which can have adverse consequences to unborn children. Hence, women who are pregnant may still undergo laser procedure without the risk of damage to their unborn child.

What Should You Look For In Selecting A Laser Surgeon ?
The most important factor in planning for your laser surgery is the surgeon who performs the procedure. Some laser procedures can be performed by well trained, experienced paramedical personnel such as a physician assistant, nurse, or medical technician.

When considering a laser surgeon, a patient should inquire about the physician's training in laser surgery, completion of appropriate laser courses and experience of the physician in performing the procedure you wish to undergo.

Drs. Clark and Flynn have extensive knowledge and experience in the use of lasers for treatment of vascular lesions and hair removal. Dr. Clark has lectured and trained physicians in the use of these lasers nationally and internationally. He has also authored a number of papers and presented talks and discussions at national and international meetings concerning his laser surgery experience.

The Aesthetic Laser Center at Cary Skin Center offers you unparalleled experience in the Southeast. Our expertise and extensive use of a variety of lasers offers you the latest technology and treatment options.

Laser Links on the Internet

American Society for Dermatologic Surgery
American Society for Laser Medicine and Surgery, Inc.