210: Nonablative Laser and Light-Based Therapy: Cosmetic and Medical Indications

Question 1

What is the principle behind selective photothermolysis in nonablative laser therapy?

Answer 1

Selective photothermolysis involves using a wavelength of light that is preferentially absorbed by a cutaneous target, applied over an appropriate pulse duration, allowing for selective destruction of a skin structure if adequate energy is delivered.

Question 2

What are the characteristics of nonablative procedures?

Answer 2

Nonablative procedures are characterized by:
- Producing biological changes without creating a clinically relevant wound.
- Necessitating minimal postprocedure wound care.
- Having a highly favorable risk profile.
- Being the clear treatment of choice for various aesthetic and medical conditions.
- Allowing for serial procedures that may yield results comparable to more invasive methods.

Question 3

What are the risks and potential complications associated with nonablative laser therapy?

Answer 3

The risks and potential complications include:
- Very low risk of complications.
- Infection, scarring, and temporary or permanent skin discoloration.
- Crusting requiring topical therapy such as emollients.
- Ocular injuries, which can be prevented with appropriate eyewear.
- Localized tissue reactions such as edema and erythema.

Question 4

What safety measures should be taken during nonablative laser procedures?

Answer 4

Safety measures include:
- Wavelength-specific eye protection.
- Posting device-specific warning signs in the treatment room.
- Covering all windows appropriately.
- Using smoke evacuators for laser plume.
- Covering reflective surfaces to avoid electrical fire risks.
- Ensuring device-specific in-service training for laser support personnel.

Question 5

What types of devices are commonly used in nonablative laser therapy?

Answer 5

Common types of devices include:
| Device Type | Wavelength | Applications |
|————-|————|————–|
| Flashlamp-pumped pulsed dye laser | 595 nm | Port-wine stains, benign vascular conditions |
| KTP laser | 532 nm | Discrete telangiectases, facial hypervascularity |
| Nd:YAG laser | 1064 nm | Facial vessels, spider veins, hair removal |
| Diode lasers | 810 nm | Hair removal |
| Alexandrite laser | 755 nm | Vascular lesions, hair removal |
| Ruby laser | 694 nm | Dermatologic applications |
| CO2 and Er:YAG lasers | 10,600 nm and 2940 nm | Resurfacing applications |

Question 6

What types of anesthesia may be used during nonablative laser procedures?

Answer 6

Types of anesthesia that may be used include:
1. Topical anesthetic creams
2. Ice applications
3. Forced chilled air
4. Local anesthesia
5. Oral or injectable analgesics
6. Regional nerve blocks
There is great variability in patient tolerance to these methods.

Question 7

What are the perioperative care considerations for patients undergoing nonablative laser therapy?

Answer 7

Perioperative care considerations include:
- No specific topical regimen required for most patients
- Use of hydroquinone for darker Fitzpatrick skin types to minimize postinflammatory dyspigmentation
- Application of petrolatum to facilitate healing
- Antibacterial antibiotics usually not required
- Prophylactic antiviral treatment for patients with a history of herpes simplex.

Question 8

What patient selection criteria should be considered for nonablative laser therapy?

Answer 8

Patient selection criteria include:
- Willingness to handle brief social downtime
- Ability to accept potentially subtle results
- Favorable risk profile for the procedure
- Consideration of age and skin type, particularly for darker skin tones due to risk of postinflammatory dyspigmentation.

Question 9

How does the treatment of vascular lesions differ from that of pigmented lesions in nonablative laser therapy?

Answer 9

The treatment of vascular lesions typically results in more dramatic and rapid outcomes, while the treatment of pigmented lesions may require serial procedures and results may develop gradually.

Question 10

What are the applications of nonablative laser systems in dermatology?

Answer 10

Nonablative laser systems are used for:
1. Nonablative dermal remodeling
2. Treatment of vascular lesions
3. Management of pigmented lesions
4. Skin rejuvenation.

Question 11

What cooling techniques are used during laser treatments to protect the epidermis?

Answer 11

Cooling techniques used during laser treatments include:
1. Dynamic cryogen spray
2. Direct contact cooling
3. Bulk cooling.

Question 12

What is the gold standard treatment for Port-Wine Stains (PWSs) and why?

Answer 12

The gold standard treatment for Port-Wine Stains (PWSs) is the pulsed dye laser (PDL) because it provides increased tissue penetration and effective treatment with relatively short pulse durations.

Question 13

What factors influence the treatment response of Port-Wine Stains to laser therapy?

Answer 13

Factors influencing treatment response of Port-Wine Stains include:
- Anatomic location
- Size of the lesion
- Age of the patient.

Question 14

What are the common characteristics and treatment options for hemangiomas?

Answer 14

Hemangiomas are characterized by benign vascular tumors appearing in the first month of life. Treatment options include observation, topical or systemic medications, and laser therapy.

Question 15

What is the role of selective targeting of hemoglobin in the treatment of vascular lesions?

Answer 15

Selective targeting of hemoglobin in vascular lesions results in thermal damage to blood vessels within treated lesions.

Question 16

What are the potential complications associated with laser treatments for vascular lesions?

Answer 16

Potential complications of laser treatments for vascular lesions include blistering, crusting, scarring, and dyspigmentation.

Question 17

What is the significance of using longer wavelengths in laser therapy for vascular lesions?

Answer 17

Using longer wavelengths in laser therapy for vascular lesions allows for deeper tissue penetration, enhancing treatment efficacy and reducing the risk of damage to the epidermis.

Question 18

What are the treatment options for telangiectasias and how do they differ?

Answer 18

Treatment options for telangiectasias include KTP and Nd:YAG lasers, and pulsed dye laser. These options differ in their effectiveness, side effects, and specific applications.

Question 19

What might be required for effective treatment of port-wine stains?

Answer 19

Multiple sessions with progressively higher fluences may be required. Dynamic cryogen spray cooling can protect the epidermis and enhance results.

Question 20

What laser is the gold standard for treating port-wine stains?

Answer 20

The flashlamp-pumped pulsed dye laser (PDL) at 595 nm is the gold standard for port-wine stains.

Significant improvement with lightening of at least 50% or better is expected in most cases.

Question 21

What laser can be used to treat vitiligo?

Answer 21

The excimer laser (308 nm) can be used to treat vitiligo by targeting depigmented areas.

Question 22

What should be considered for patients with a history of keloid formation seeking laser treatment for acne scars?

Answer 22

Patients with a history of keloid formation should be treated cautiously, as laser therapy may exacerbate scarring. Fractionated nonablative devices may be safer options.

Question 23

What is the expected outcome of using a 1550-nm erbium-doped fiber laser for acne scars?

Answer 23

The 1550-nm erbium-doped fiber laser is effective for nonablative dermal remodeling, leading to gradual improvement in acne scarring with minimal downtime.

Question 24

What laser might be used for treating psoriasis?

Answer 24

The excimer laser (308 nm) is sometimes used to treat psoriasis by targeting affected areas with ultraviolet light.

Question 25

What are the advantages of using Q-switched lasers for pigmented lesions?

Answer 25

Q-switched (QS) lasers can lighten the color of pigmented lesions, aiding in the diagnosis of malignancies, and provide a more predictable outcome compared to other methods like cryotherapy.

Question 26

What are key considerations for laser hair removal?

Answer 26

Key considerations include hair color, hair thickness, skin type, pre-treatment care, and post-treatment care.

Question 27

What complications are associated with laser hair removal?

Answer 27

Complications can include erythema, perifollicular edema, paradoxical new hair growth, and dyspigmentation.

Question 28

How do Q-switched lasers differ in effectiveness for treating lentigines and seborrheic keratoses?

Answer 28

Q-switched lasers are effective for lentigines and thin seborrheic keratoses, with varying healing times.

Question 29

What are traditional and modern methods for tattoo removal?

Answer 29

Traditional methods include excision and dermabrasion. Modern methods include Q-switched lasers that target specific ink colors.

Question 30

What is the role of Q-switched lasers in treating pigmented lesions?

Answer 30

Q-switched lasers lighten the color of pigmented lesions without significantly increasing the risk of malignant degeneration.

Question 31

Why are longer-wavelength devices preferred for hair removal in darker skin tones?

Answer 31

Longer-wavelength devices like the 1064-nm Nd:YAG laser reduce the risk of complications while effectively targeting deeper pigment-containing structures.

Question 32

What is the significance of using a cooling system during laser hair removal?

Answer 32

A cooling system minimizes epidermal damage and reduces the potential for complications during the procedure.

Question 33

What are the mainstays of treatment for melasma?

Answer 33

Mainstays include topical therapies, avoidance of exacerbating factors, and new protocols using low-fluence QS 1064-nm Nd:YAG lasers.

Question 34

What are the differences in treatment outcomes between Q-switched lasers and IPL for lentigines?

Answer 34

Q-switched lasers provide more immediate results, while IPL treatment results are more gradual and typically require multiple sessions.

Question 35

What is the role of laser therapy in managing Becker nevi?

Answer 35

Laser therapy can treat Becker nevi, although the response may be inconsistent, and laser hair removal can reduce hair density.

Question 36

How do Q-switched lasers work in tattoo removal?

Answer 36

They use photoacoustic and photomechanical effects to target ink colors, breaking down ink particles for clearance.

Question 37

What precautions should be taken before laser hair removal treatments?

Answer 37

Patients should avoid alternative hair removal methods and follow strict perioperative sun precautions.

Question 38

What are the indications for nonablative laser therapy for vascular lesions?

Answer 38

Indicated for treating angiomas and venous lakes, effective results are typically achieved after only 1 or 2 treatment sessions.

Question 39

Which laser is recommended for Fitzpatrick type IV skin seeking hair removal?

Answer 39

The 1064-nm Nd:YAG laser is recommended due to its reduced risk of dyspigmentation.

Question 40

What alternative approach could be considered for a patient with melasma resistant to QS laser and IPL treatments?

Answer 40

Nonablative fractionated laser therapy with conservative energy levels can be used, along with new protocols using low-fluence QS 1064-nm Nd:YAG lasers.

Question 41

What lasers are effective for treating nevus of Ota?

Answer 41

QS ruby, alexandrite, and Nd:YAG lasers are effective, with multiple treatments usually required for maximal correction.

Question 42

What laser is effective for pseudofolliculitis barbae?

Answer 42

The 1064-nm Nd:YAG laser is effective, especially in patients with darker skin tones.

Question 43

What lasers can be used for treating café-au-lait macules?

Answer 43

QS lasers with various wavelengths can be used, but recurrence is possible even after clinical resolution.

Question 44

What device is recommended for treating rosacea-related facial redness?

Answer 44

IPL systems are commonly used and effective for treating facial redness associated with rosacea.

Question 45

What treatment is effective for hypervascular poikiloderma of Civatte?

Answer 45

Pulsed dye laser (PDL) treatments are effective for this condition.

Question 46

What pre-treatment advice should be given to patients seeking laser hair removal?

Answer 46

Patients should avoid waxing, threading, and plucking before treatment, while shaving is acceptable.

Question 47

What might cause paradoxical hair growth after laser treatment in Fitzpatrick skin type III?

Answer 47

Paradoxical new hair growth can occur, especially at the margins of treated skin.

Question 48

What immediate effect might occur after treating lentigines with lasers?

Answer 48

A white frosting of the epidermis may appear immediately after treatment, representing intraepidermal water vapor.

Question 49

What challenges might be faced when treating Becker nevus?

Answer 49

Becker nevi respond less consistently to QS laser therapy, and recurrence is possible.

Question 50

What laser is effective for unwanted leg veins?

Answer 50

The long-pulsed Nd:YAG (1064-nm) laser is effective for smaller prominent leg veins.

Question 51

What is the principle of selective photothermolysis in tattoo removal?

Answer 51

It involves using nanosecond-range pulse durations of QS lasers that match the size of subcellular ink particles.

Question 52

Which laser types are effective for removing black and dark blue inks?

Answer 52

Effective laser types include QS Nd:YAG (1064-nm), QS Alexandrite (755-nm), and QS Ruby (694-nm).

Question 53

What challenges are associated with removing yellow ink tattoos?

Answer 53

They can be difficult to eliminate, often requiring multiple sessions and sometimes local anesthetics due to pain.

Question 54

What are common side effects of laser tattoo removal?

Answer 54

Common side effects include edema, blistering, crusting, and pinpoint bleeding.

Question 55

What is the R20 treatment method in tattoo removal?

Answer 55

The R20 treatment method involves multiple treatment passes on the same day, which may decrease the time to tattoo clearance.

Question 56

What is the significance of using picosecond lasers in tattoo removal?

Answer 56

Picosecond lasers may achieve tattoo clearance in fewer treatments for some ink colors.

Question 57

What potential allergic reactions can occur with tattoo inks during laser treatment?

Answer 57

Reactions can include pruritus, induration, and erythema, requiring counseling for excision or treatment.

Question 58

How do ablative and nonablative resurfacing devices work in skin treatment?

Answer 58

They target water as the chromophore, inducing dermal remodeling and neocollagenesis.

Question 59

What is the role of pulsed dye lasers in treating scars?

Answer 59

Pulsed dye lasers target telangiectatic vessels within scar tissue, effective for treating conditions like erythematous striae.

Question 60

What is the principle of selective photothermolysis and its relation to tattoo removal?

Answer 60

It involves using nanosecond-range pulse durations of QS lasers that match the size of subcellular ink particles.

Question 61

What factors influence the response of tattoos to laser treatment?

Answer 61

Factors include ink color, tattoo age, and ink composition.

Question 62

What are the treatment options for erythematous striae and hypervascular scars?

Answer 62

Options include vascular-specific lasers and pulsed dye lasers, often requiring serial treatments.

Question 63

What is the role of ablative and nonablative resurfacing devices in skin treatment?

Answer 63

They are used to improve the quality and texture of the skin.

Question 64

What are treatment options for erythematous striae and hypervascular scars?

Answer 64

Treatment options include vascular-specific lasers, pulsed dye lasers, and serial treatments combined with intralesional injections of corticosteroids or 5-fluorouracil.

Question 65

What is the role of ablative and nonablative resurfacing devices in skin treatment?

Answer 65

They improve skin quality and texture by targeting water as the chromophore, inducing dermal remodeling and neocollagenesis.

Question 66

What precautions should be taken when treating tattoos with QS lasers?

Answer 66

Precautions include conducting small test areas, monitoring for allergic responses to the ink, and avoiding treatment in patients with localized chrysiasis due to systemic gold therapy.

Question 67

What challenges might you face when removing a tattoo with yellow ink?

Answer 67

Yellow ink is particularly resistant to removal. The QS 532-nm laser is typically used, but complete elimination may be difficult, requiring multiple sessions and patient counseling.

Question 68

What complication should you be cautious of when treating a patient with a history of systemic gold therapy?

Answer 68

Localized chrysiasis, characterized by blue-gray discoloration of the skin, can occur due to structural alterations in dermal gold deposits.

Question 69

What should you counsel a patient with a large, multicolored tattoo about the treatment process?

Answer 69

Large, newer, multicolored tattoos are the most difficult to eliminate, requiring numerous treatment sessions, with some colors being particularly resistant.

Question 70

What is your recommendation for a patient with a history of allergic reactions to tattoo ink seeking QS laser treatment?

Answer 70

QS laser treatment should generally be avoided, and signs of an allergic response should be addressed by excising or otherwise treating the offending ink.

Question 71

What laser would you use for treating a patient with erythematous striae?

Answer 71

Vascular-specific lasers, such as pulsed dye lasers, are effective for treating erythematous striae by targeting telangiectatic vessels.

Question 72

What laser would you use for removing embedded particles in a patient with a history of gravel injuries?

Answer 72

QS lasers of various wavelengths are effective for removing embedded particles such as gravel.

Question 73

What combination therapy would you consider for a patient with a hypertrophic scar?

Answer 73

Laser therapy may be combined with intralesional injections of corticosteroids or 5-fluorouracil.

Question 74

What complication might occur with titanium dioxide-containing tattoo ink during removal?

Answer 74

Inks containing titanium dioxide may undergo an oxidization reaction when laser energy is applied, causing an immediate darkening effect.

Question 75

What laser would you use for a patient with a history of striae rubra?

Answer 75

Pulsed dye lasers are effective for striae rubra as they target telangiectatic vessels within the stretch marks.

Question 76

What lasers would you use for different colors in multicolored tattoos?

Answer 76

Black and dark blue inks: QS Nd:YAG (1064-nm), QS alexandrite (755-nm), QS ruby (694-nm). Red ink: Frequency-doubled QS Nd:YAG (532 nm). Blue and green inks: QS alexandrite, QS ruby, or picosecond-based lasers.

Question 77

What should you tell a patient about expected results from fractional laser treatment for scars?

Answer 77

Fractional laser treatment induces dermal remodeling and neocollagenesis, leading to improvements in skin quality and texture, with serial treatments often required for optimal results.