The word cosmetic is defined as serving to beautify or used or done superficially to make something look better, more attractive, or more impressive. Cosmetic plastic surgery is used to change the form or appearance of the normal face and body to make these structures look good or more beautiful. An example of cosmetic plastic surgery would be a face lift or breast augmentation. Cosmetic plastic surgery is different from reconstructive plastic surgery which is used to change the form and improve function of damaged or deformed facial and body structures. Skin grafting for burns, correcting a cleft lip or palate or breast reconstruction after mastectomy would be examples of reconstructive plastic surgery.
Cosmetic laser surgery involves the use of laser light waves or photo therapy to beautify and improve the form and appearance of normal face and body structures. Although the term cosmetic laser surgery is applied to a wide variety of aesthetic or cosmetic laser procedures, most of the procedures are not truly invasive surgery. While some cosmetic laser procedures involve an incision, most do not break the skin, and achieve their cosmetic result with minimal skin injury. The ability of cosmetic laser surgery to alter or improve the appearance of the face or body without a surgical scalpel and without creating scars is the revolutionary aspect of cosmetic laser surgery.
Cosmetic laser surgery has dramatically changed cosmetic and aesthetic plastic surgery during the past 10 years. The perception that cosmetic laser surgery can be done with the press of a button has led many people to believe that lasers are miracle machines that anyone, trained surgeon or otherwise can use and get good results. This is far from the truth, as lasers are very complex, potentially harmful medical devices.
The use of a laser on the human body requires medical and surgical education in laser safety, laser tissue interactions, and safe medical and surgical techniques.
In this article I will try to explain for you, the potential patient or interested reader, what cosmetic laser surgery can do for you and how the cosmetic or aesthetic lasers work. I will cover the most common situations in which these techniques are the best choice for aesthetic treatments. I will give you general information on how you can find the appropriate doctor to have a safe and effective treatment.
How is cosmetic laser surgery used to improve or beautify your appearance?
Cosmetic laser eyelid surgery-Eyelid rejuvenation is the most common incisional surgical application of the laser in plastic surgery. The CO2 laser blepharoplasty is used to remove excess skin or hoods from the upper eyelid. The technique is also used to remove bags under eyes, puffy eyes and dark circles under the eyes. A new technique called the transconjunctival laser blepharoplasty performs lower eyelid rejuvenation through a tiny incision on the inside pink part of the eyelid. This technique avoids a visible scar on the eyelid. It also avoids changing the natural shape of the eyelid, a complication which often happens with traditional scalpel blepharoplasty done through an external incision.
Before and after picture of transconjunctival laser blepharoplasty to remove bags under eyes.
Laser Liposuction-Liposuction is the newest application of the laser to a common plastic surgery operation. In this technique a small laser fiber is inserted beneath the skin to melt the fat and tighten the skin before fat is removed by suction. Because the fat is liquefied, it is easier to remove and tiny tubes called cannulas are used to remove the liquefied fat by suction. The result is much smaller, hidden incisions, less trauma, and quicker recovery, in my experience. Laser liposuction results so far have shown smoother skin after laser liposuction without the lumps, bumps and skin irregularities often see with the traditional liposuction procedure.
Before and after picture of laser liposuction of abdomen for laser body sculpting.
Cosmetic laser skin wrinkle removal-laser skin resurfacing-Skin resurfacing to remove wrinkles and tighten facial skin was the first major cosmetic or aesthetic plastic surgery application of cosmetic laser surgery. In the beginning CO2 lasers were used, but prolonged healing and hypo pigmentation (whitening) of the treated skin were major disadvantages. In recent years fractional Erbium laser skin resurfacing has drastically reduced recovery and complications. The new fractional skin resurfacing breaks the laser beam into many small beams which leave intact areas of skin behind which promote healing and lessen recovery time and complications.
Before and after picture of fractional laser skin resurfacing to improve skin texture and smooth fine skin wrinkles.
Laser skin tightening-CO2 skin resurfacing produced dramatic skin tightening but fell from favor because of the prolonged healing and loss of skin pigment mentioned above. Several different skin tightening methods have been developed using radiofrequency and infrared energy. These include Thermage, Titan, LuxIR Deep, Refirme and others. However these newer techniques achieve only about 20% tightening of the skin and in my experience results have been disappointing. The newest skin tightening technique uses the laser liposuction fiber placed beneath the skin, and results so far have been excellent in my experience.
Laser removal of brown spots and sun damage on skin- A different type of laser is used to remove brown spots from the skin. These techniques are non-ablative, which means that only the brown pigment is removed and the normal skin is not ablated or removed. In recent years Intense Pulsed Light (IPL) is more commonly used to remove brown spots, because the IPL technique is gentler and there is less risk of skin injury.
Laser stimulation of new skin collagen or skin plumping laser treatments-Sun damage and aging destroy the collagen in the deep layer of our skin called the dermis. The dermis is that pink or red tissue that you see when you scrape your knee. When the dermis of the skin loses collagen, the skin becomes lax and wrinkles. This is similar to what happens when you dry a full juicy plumb in the California sun. In time the plumb loses its water and shrivels into a wrinkled prune. When the dermis is irritated or inflamed it responds by producing new collagen to plump the skin and fill wrinkles. New, non-ablative fractional erbium resurfacing lasers can go through the surface of the skin and inflame the dermis and cause the production of new collagen. Examples are the Fraxel and the Lux1440 and Lux1540 Erbium machines. Becuase the skin is not ablated there is minimal redness and recovery time.
Laser acne scar removal-Acne scars are caused by the destruction of the dermis caused by the acne skin papule. This acne lesion is an infection of the skin, and the infection destroys the dermis and creates a sink hole in the skin, the acne scar. The new non-ablative fractional resurfacing techniques mentioned above can build new collagen in the dermis to plump acne scars. If skin irregularities are left after non-ablative fractional erbium skin resurfacing, ablative fractional laser skin resurfacing with a 2940 Erbium laser can be used to smooth the skin.
Laser skin scar removal-Scars from any cut or trauma, or surgery, are caused by a disruption and damage to the dermis beneath the skin. The non-ablative fractional Erbium laser skin resurfacing technique can also be used to improve these other types of scars. In my experience, the results can be dramatic. If scars are red, the IPL can be used to lessen the redness of scars.
Laser removal of excess skin blood vessels spider veins, and Rosacea-The 532 and Argon lasers were the first ones used to remove blood vessels and spider veins from the skin. These wavelengths are absorbed by the color red, thus when they are radiated on blood vessels that contain blood, the light energy heated the blood and damaged and closed the blood vessel. More recently, IPL is used more frequently to treat blood vessels because the IPL is a gentler procedure with less risk of skin injury. On larger spider veins on the legs, a 1064nm wavelength is most frequently used today.
Laser hair removal-Hair removal is the most common application of cosmetic laser surgery in use today. The laser beam is absorbed by the pigment in the hair follicle, heats the follicle and damages the tissue. The hair follicle is scarred and shrinks but is not permanently killed. After these treatments, the follicle produces a small blond (velum) hair.
Laser tattoo removal-Tattoos can be successfully removed with these techniques. The benefit is that a surgical scar caused by surgical removal of the tattoo is avoided. However laser tattoo removal requires many repeated treatments over a year or more. In addition, a ghost or white area can be left behind where the tattoo was originally located.
How do cosmetic lasers work?
Cosmetic laser surgery works by heating tissue. Laser generated heat can be used to vaporize or remove unwanted skin tissue like a skin wrinkle. Heat can also be used to stimulate the new growth of tissue for example new collagen in the skin. What is so special about this technique is that the heat produced can be very specifically and accurately directed to heat only the tissue that is to be removed or affected, and not heat the normal surrounding tissues that are to be left in place.
The specificity or accuracy of this tissue heating is based on the fact that laser light is monochromatic, that is of one color, depending on the particular wavelength used. This light is also coherent, which means it is uniform, and this coherence or focusing of this light makes the beam very powerful.
A laser beam can be directed to heat and destroy a very specifically colored skin target such as a red blood vessel. A red laser beam with a wavelength of 532nm (nm is the abbreviation for nanometer which is one billionth of a meter and is a term used to describe the laser wavelength of light in the visible light spectrum) which is in the red portion of the visible light spectrum, will be absorbed by anything that is red. When the 532nm beam is applied to a blood vessel which contains red blood, the blood is heated, the blood boils and injures the blood vessel wall, and the blood vessel closes. This is how cosmetic laser surgery is used to remove spider veins on the leg, small blood vessels on the face, and the small blood vessels that cause Rosacea.
This process is called target specific photothermolysis. What this means is that the light beam can heat and destroy or change a very specific target based on its color. Photothermolysis means light (photo) heat (thermo) disintegrate or dissolve (lysis).
For you techies, the word laser stands for Light wave Amplification by Stimulated Emission of Radiation. These amplified light beams are very powerful (amplified) light beams (radiation) that is emitted (emission) from a tube which is designed to create one specific color or wavelength of light. A complex electrical method is used to stimulate (stimulated) the light into a powerful amplified state. Cosmetic surgical lasers are designed to emit or produce specific colors which are highly and specifically absorbed by different tissues of the human body.
What wavelengths are used in cosmetic laser surgery?
There are hundreds of different laser wavelengths that can be tuned to vaporize very specifically colored biologic targets on the human body. The color of hair, blood vessels, tattoos, veins, arteries, pigment in brown spots and other colors can each be specifically targeted best by one particular laser wavelength. The trick is to produce the specific wavelength that is needed for the application you desire. Some common wavelengths used in cosmetic laser surgery are:
532nm-Absorbed by red-purple-used to vaporize blood vessels and spider veins and red tattoos
755nm-Absorbed by brown-black and used for hair removal and tattoo removal
924nm- The 924nm is absorbed by the color yellow and is used to dissolve fat during liposuction
1064nm-Absorbed by water and used for hair removal, closure of large veins, and in laser liposuction
1308-Absorbed by fat and used in Laser liposuction
1440nm and 1540nm-Erbium absorbed by water and used to coagulate deep collagen in the skin to stimulate new collagen and plump skin wrinkles and acne scars
2940nm-Erbium absorbed by water, vaporizes cells, used to resurface the skin and remove wrinkles
10,000nm-CO2 absorbed by water inside the skin cells, ruptures the skin cell, used for incisions and to vaporize skin growths
Which doctors are experts at cosmetic laser surgery?
Lasers were first used in dermatology and otolaryngology as non specific heating devices to destroy cancerous lesions in a manner similar to traditional electrocautery. Only after lasers were refined to selectively heat specific tissues were cosmetic laser surgery applications possible.
The first of these new cosmetic laser surgery techniques was formally introduced to plastic surgeons in 1995 yet many have been very slow to adapt to the new technology. The new technology is very expensive and requires a significant investment in new equipment.
More importantly, I believe is that these new cosmetic laser techniques require a totally different approach to surgery. In traditional plastic surgery the surgical scalpel, and thus the surgeons hand is always in contact with the patients skin. With cosmetic laser surgery, all cutting is done with a light laser beam and thus direct physical contact with the patients skin by the surgeon does not occur.
In my personal view, a different part of the surgeons brain is used with this new technique. Older scalpel procedures are manual and the left side of the brain is used. This new type of surgery is more of a spatial, visual task that uses the right side of the brain. This requires that the plastic surgeon re-learn basic surgical techniques. After many years of training in a left brain task, re-learning and adapting to a right brain technique is a difficult and challenging task.
You will have to ask your plastic surgeon if he/she uses these new light based cosmetic photo therapy techniques. The following are good places to start your search:
Check the American Board of Plastic Surgery to find a board certified plastic surgeon in your area
Check the American Society of Plastic Surgeons to find a plastic surgeon in good standing in your community
Check the American Society of Aesthetic Plastic Surgeons to see if your plastic surgeon is experienced in and specializes in aesthetic or cosmetic plastic surgery.
Check American Society of Lasers in Medicine and Surgery for more information on the use of lasers in medicine and surgery.
Be careful to choose a plastic surgeon certified by the American Board of Plastic Surgery. There are many non-surgeons who offer these advanced techniques. Dont be fooled, you want a trained board certified plastic surgeon if you are considering having surgery with these new techniques. There are many board certified dermatologists who are expert at the non-surgical treatments using these new techniques.
Cosmetic laser eyelid surgery in particular is a very significant advance in eyelid rejuvenation. Do your homework and find an expert. Let these exciting new aesthetic techniques help you look as good as you feel.
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