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As long as there have been wrinkles and scars, someone has tried to smooth the skin. As the population ages, the demand for safe resurfacing is sure to continue increasing. Laser treatment offers the potential for long-lasting effect by stimulating collagen production in the skin. Over the past 15 years, laser technology has undergone a substantial evolution. Ablative devices, though very effective, are much less popular now because of difficult healing and the risks of scarring and infection. Early nonablative devices eliminated the downtime but suffered from marginal effectiveness. The latest crop of devices is a significant improvement, but I hope that the field continues to evolve.
One of the most common manifestations of aging is the appearance of unwanted blood vessels. The blood vessels can manifest in a stunning variety of shapes and sizes, each responding differently to the same technology. I believe it currently takes an experienced and intelligent laser practitioner with more than one device to correctly match the vessel to the laser parameter for the best results. Factor in the variety of skin types, and there is no cookbook approach. This very well-written article by Dr. Wall gives an outstanding discussion of a topic that is difficult to master.
Treating children with laser therapy can be challenging. The patients may be uncooperative and the parents demanding. Even so, the reward is the potential of decreasing or eliminating the disfiguring appearance of a vascular lesion. In a child, the ultimate payoff is increased self-esteem and ultimately better overall development psychologically. We are privileged to have an excellent and comprehensive contribution from Drs. Cole, Sonabend, and Levy on the treatment of a variety of vascular lesions and the lasers used in their treatment.
Although often dismissed as a minor condition by those who do not suffer from it, acne is of great concern to many children and adults. Patients often fail or find difficulty in complying with complicated skin care regimens. In addition, the most effective medical treatment, isotretinoin, has become difficult to prescribe because of federally mandated restrictions due to the risks of teratogenicity and depression. As any dermatologist will report, acne patients can be eternally grateful or chronically frustrated. Laser therapy for acne has blossomed over the past 7 years from nothing to high popularity because of a combination of effectiveness, convenience, and potential long-term effect. Unfortunately, the myriad number of techniques and platforms is confusing, and this difficult topic is very nicely presented by Drs. Jih and Kimyai-Asadi.
How many times have you been astounded that the person standing in front of you has a tattoo? There is a good chance that that person would remove the tattoo if given a choice. The combination of wide popularity along with eventual dissatisfaction has created a very large demand for tattoo removal. Current laser options are effective and unlikely to leave a scar. Unfortunately, even the best laser surgeon with the most effective device is likely to have his share of disappointed patients who either do not respond or give up too soon. This article by Dr. Bernstein is an excellent review of laser tattoo removal.
One of the most complicated issues in the field of laser medicine starts as a simple question: Who can use a laser device? As a result of differing state laws and unclear ethical boundaries, a wide variety of people now offer laser treatment, sometimes in a nonmedical environment. Laser companies, in an attempt to increase sales, now target a wide variety of physicians and non-physicians instead of the traditional market of dermatologists and plastic surgeons. Often, profit is marketed at the expense of a real discussion of laser safety and appropriate use. Even in the best of hands, patients sometimes suffer side effects. In the worst of hands, there can be total disaster. In my opinion, both the laser surgeon and the person using the machine should be experts in laser treatment. Anything less is an easy pathway to scarring or worse. I urge any practitioner who delegates or considers delegating to read the following article by Dr. Alam, which is rich in detail and substance.