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Two treatment modalities that are extremely
useful in the treatment of various skin
conditions are Laser and Intense Pulsed
Light (IPL). Both involve harnessing
energy from light waves but they differ
in how the light waves are 'packaged' and
delivered to the skin. For a light
treatment to be effective in this way, the
energy from the light must be absorbed by
some component of the skin. Different
wavelengths of light (equivalent to different
colours of light) have different absorption
characteristics and we utilise this property
to treat different conditions. We
select IPL or Laser wavelengths so that
we can target different components of the
skin depending on what we want to achieve;
so when wanting to rejuvenate the skin we
target the protein collagen in the deeper
(dermis) layer of the skin; whereas for
hair removal we target the pigment melanin
in the hair shaft and for treating vascular
blemishes, such as Rosacea or thread veins,
we target the red pigment called haemoglobin
that carries oxygen in blood cells.
In this way we can use the heat or mechanical
energy produced by the light to damage selectively
one component of the skin, without, hopefully,
damaging the others.
It is important that these treatments are
carried out only on those pigmented blemishes
which have a negligible risk of cancerous
change and so you should ensure you are
either treated by someone who is medically
qualified and has the expertise to assess
these blemishes, or that you have had an
examination by an expert first. I
am a Consultant Plastic Surgeon with a special
expertise in melanoma and other skin cancers,
working in partnership with Dermatologists
and Oncologists in a regional centre for
these cancers. I will always assess
your skin clinically before considering
any treatment.
Vascular Skin Blemishes
Vascular skin blemishes such as Port Wine
Stains; Thread Veins; Telangectasiae; Spider
Naevi and Rosacea can be treated with either
laser or IPL. I use a state-of-the-art
system that allows me to treat you with
either modality, and to switch between them
as required.
How
does IPL or Laser work on vascular blemishes?
The wavelength of the light used is chosen
so as to be absorbed by haemaglobin in the
cells within blood vessels travelling in
the epidermis and dermis preferentially.
Inside a vascular skin blemish, the blood
vessels are overgrown or in higher concentrations
than surrounding “normal skin”.
When these blood vessels absorb the light,
they heat up and are destroyed, whilst minimal
collateral damage is caused to the surrounding
skin. Following successful treatments,
the damaged blood vessels are absorbed by
the body, and little or no trace of the
blemish remains.
Exactly the same principle applies to treatment
with a laser. The laser can give a
more powerful and selective treatment, but
over a smaller surface area each time, and
so is not usually my first choice because
it will take me longer to achieve a finished
result for you, involving you in more expense,
time and treatments. I tend to use
the laser therefore, on blemishes that are
resistant to treatment with IPL or on people
with darker skins because it is very gentle
on dark skin types, so almost all skin types
can be treated with the NdYAG laser.
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How
is the treatment carried out?
First the skin being treated is cooled using
a jet of refrigerated air. Then for
IPL treatments, a thin layer of gel is applied
to the skin prior to treatment, which both
cools the skin further and optimises transmission
of light from the applicator to the skin.
Your first treatment will occur at the end
of your consultation, and will consist of
several treatment 'test patches' which will
allow me to assess the response of the blemish
to the treatment and to ascertain at which
power to treat your blemish subsequently.
During treatment you must wear protective
eye goggles.
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Which
patients can be treated?
In everyone, the outer layer of the skin,
the epidermis, contains melanin which is
a very good absorber of light, which is
why it is utilised by our bodies as the
skin’s natural defence against harmful
ultraviolet radiation from the sun. The
concentration of melanin in the skin is
greater in darker skinned people and increases
in light skinned people when the skin is
exposed to UV light. The light emitted
by the IPL system or Laser is absorbed to
a certain extent by melanin in your skin
as well as the blood vessels; and the portion
of the light that is absorbed by melanin
will produce unwanted, incidental heat in
the skin. So the more melanin
in the skin, the more heat will be produced,
which could produce a burn. Therefore,
it is not possible to treat very dark-skinned
individuals with IPL (although they may
be suitable for treatment with a Laser)
or patients who have recently gained a sun
tan (although they can subsequently be treated
once their tan has faded).
If you have any areas of broken skin, treatment
will be delayed until the area is healed
completely.
Some vessels are not suitable for laser
treatment: very large bore blood vessels
and varicose veins cannot be treated.
Some deep lying or blue veins can be treated,
but will usually require more treatments
than smaller red veins.
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Will
it hurt me?
When light energy is absorbed in the skin,
it heats it up, and creates a sharp sensation
like a hot pinprick. Most patients
describe the discomfort as moderate and
acceptable. No anaesthesia is required,
but to ease the discomfort I use a cold
gel for IPL treatment in combination with
a refrigerated air jet that you control
during your treatment. For Laser treatments,
the refrigerated air jet, followed by a
cooling gel after treatment usually suffices.
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What should I expect
after the treatment?
Redness and a slight burning sensation in
the skin are normal after treatment.
A cooling pack will be applied to the skin
to ease these symptoms. You may see
a temporary grey colouration in the vessels.
Some vessels disappear immediately, so you
won't see them again!
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What
are the side effects?
The visible light used in IPL is completely
safe so no special precautions are needed
apart from wearing protective glasses during
treatment.
The skin of some patients becomes quite
red immediately after treatment and in rare
cases some bruising may be seen. However,
most patients experience no side effects
and any redness or bruising usually disappears
over a period of hours to a few days.
Very rarely the natural pigment in the skin
may increase or decrease as a result of
treatment, and this may be permanent.
If you have been exposed to sun a day or
so before treatment and have not yet developed
a tan, you may still have enough extra melanin
in your skin to burn, and then your skin
will blister and scab after treatment and
this may scar ultimately ' so avoidance
of the sun and tanning before treatment
is vital.
Back
to top
How do I prepare for treatment?
You must avoid the sun, or using either
a tanning salon or any fake tan for 6 weeks
before, or during the entire treatment period
to avoid burns from light absorption in
the epidermis.
Also, immediately after the treatment, the
skin is particularly sensitive to UV light,
and strong sunlight should be avoided for
1-2 weeks.
How
long does treatment take?
The length of each treatment will depend
on the type and size of lesion present,
but a typical session for Rosacea might
take 15 - 30 minutes.
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How
many treatments are necessary?
The length and number of treatments will
depend on the type and size of lesion present,
but typically 1-5 treatments will be needed.
Treatments should take place approximately
every 4 to 6 weeks for IPL and every 6-8
weeks for laser.
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Hair Removal
In order to remove
hair I will use either IPL at a wavelength
of 650nM or a long-pulse NdYAG laser depending
on how dark your skin is. Both methods
are targeting melanin in your hair shaft
in order to heat up and kill the hair follicle
and neighbouring cells responsible for re-growth
of the hair.
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How
is the treatment carried out?
The skin will be cooled down prior to treatment,
to prevent unwanted heating of the epidermis.
The IPL or laser will be placed directly
over the skin bearing the unwanted hair
and fired. During treatment you must wear
protective goggles.
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Which
patients can be treated?
Black hairs are most easily treated due
to the large concentration of melanin in
these hairs, which gives the most absorption
and creates the most heat. Fair hair
has less melanin and consequently less heat
is produced with less certainty of permanent
destruction of the hair follicles.
Grey (white) hair has almost no melanin
and cannot be treated effectively.
The light emitted by Nd:YAG laser is especially
gentle to dark skins, which means that it
is the laser best suited for the treatment
of Afro-Caribbean and the darker Asian skin
types.
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Does
it hurt?
As the light energy is taken up by melanin,
any discomfort depends upon the combined
concentration of melanin in the epidermis
and the hairs. No anaesthesia is required.
Most patients describe the discomfort as
moderate and acceptable, and liken it to
a rubber band being flicked against the
skin.
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Do
I need to shave prior to treatment?
Hair should be shaved just before, or on
the morning of treatment ' in many
ways, it is easier to leave it for me to
do just before treatment as that will allow
me to see what needs treating! The
guiding principle for successful treatment
is that as many hair follicles as possible
should contain a hair on the day of treatment
in order to be destroyed by the light.
Do not pluck, wax
or bleach hairs for at least 4 weeks before
treatment or the treatment will fail and
you will waste your money!
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Why
do hairs “grow” after treatment?
They don’t really, but they do appear
to grow. The hairs are not always
evaporated by this particular treatment
in the way that some other light treatments
do. Although the hair follicles are
killed by the heat generated during the
treatment, the hair shafts may remain in
the follicles. They will fall out
after 1-3 weeks as the epidermis is renewed.
During this period it will seem that the
hairs are growing because they are being
pushed out of the epidermis.
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How can you tell if the treatment has worked
when the hairs are not removed immediately?
After treatment the hairs are loose in the
follicle and can sometimes be pulled out
easily and painlessly with tweezers.
A red ring around each follicle is often
seen a few minutes after treatment, along
with reddening of the skin. These
end points indicate that sufficient heating
of the follicles has taken place, however
they are not always seen. Many patients
have successful treatment results without
these positive post-treatment signs.
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What
are the side effects?
The skin of some patients becomes quite
red immediately after treatment. However,
most patients experience no side effects
and the described skin reactions usually
disappear within hours to a few days.
Rarely the natural pigment in the skin may
increase or decrease as a result of treatment,
and this may be permanent. Occasionally
the treated skin may form blisters and then
scab following treatment. These areas
should be left alone to heal naturally.
It is important to avoid scratching or picking
scabs or blisters as this could result in
scarring.
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How
many treatments are necessary?
Of all the hairs on your body a variable
number (10- 70%) are growing at any one
time; the remainder are either resting or
are about to fall out. Only hair that
is growing when treatment occurs can be
killed and removed permanently. Because
the number of hairs in the growing phase
varies, as does the length of the growth
cycle of each hair, you will notice that
a significant reduction in hair density
occurs after the first treatment, but that
not all of the hair in the area treated
will have gone. More treatments will
be needed to get the hairs that were resting
or about to fall out last time. With
each successive treatment, a smaller proportion
remain and those that do tend to be finer.
To achieve satisfactory results, treatment
sessions are recommended every 4-6 weeks
and the number of sessions needed varies,
according to individual factors, but the
usual number is 8-10.
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How
do I prepare for treatment?
You must avoid the sun, sun lamps or the
use of any fake tan 6 weeks ahead of and
during the entire treatment period to avoid
discomfort from light absorption in the
epidermis and the risk of burns and permanent
scarring.
Immediately after the treatment the skin
is particularly sensitive to UV light, and
strong sunlight should be avoided for 1-2
weeks.
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How
long does treatment take?
A facial treatment usually takes 15 minutes,
whereas treating both legs or an entire
back takes approximately 2 hours.
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Is
permanent hair removal possible?
Currently-used technology is only a few
years old, so we do not know definitively
for how long these treatments are effective,
but they seem to be lasting years.
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Tattoo
Removal
For removing tattoos I use a Q switched
NdYAG laser which will remove most tattoo
pigments effectively except green.
How
does a laser remove a tattoo?
The short answer is that it doesn’t
- the laser allows the body to remove the
tattoo. Tattoos are made of ink contained
in layers throughout the skin. The
ink particles are recognised by the body
as foreign material, but they are too large
for the cells that digest foreign material
to tackle, so instead, the body encapsulates
the tattoo ink in a collagen protein coating
to wall it off. The laser works by
breaking down the collagen wall and fragmenting
the ink particles till they reach a small
enough size for the body’s defence
cells to digest and excrete them.
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How
many treatments will I need?
Many variables will determine this and I
never make a prediction; I just give you
the facts and you can see for yourselves
that your individual circumstances may mean
a shorter or longer treatment span:
The number of treatments
required to remove a tattoo will depend
on:
1: The amount of pigment present and the
variability of the depth of the pigments
in the skin (for instance professional tattoos,
made with an electric needle, tend to place
pigments at the same level in the skin,
whereas amateur tattoos are more haphazardly
distributed in the skin’s layers)
2: The colours and constituents of the tattoo
pigments
3: The density, type and age of the tattoo
4: The skin’s reaction to laser light
5: The presence of other skin conditions
Generally you can expect
a gradual fading after each treatment as
the body digests the shattered ink particles
at its own speed until, after enough treatments,
no ink remains. It is not possible
to assess exactly the depth and density
of a tattoo prior to treatment and therefore
any estimate of the number of treatments
required will always only be an educated
guess.
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Which
colours are best to treat?
The treatment of colours other than blue
and black can be difficult. The colour
that is hardest to treat is green and I
do not have a laser that will treat green
ink.
Certain new types of fluorescent tattoos
do not respond to laser treatment and will
be left behind after the rest of the tattoo
is removed and this is not predictable before
we start treatment! Moreover, some
modern pigments may change colour after
treatment and again, this is impossible
to predict. But as a rule of thumb,
if a tattoo is particularly dense or brightly
coloured it is likely that some pigment
will remain after the course of treatment
is complete.
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What
should you expect from treatment?
Tattoo removal is a medical process relying
in part on your body’s cellular defence
mechanisms, so it is essential that you
advise me of all relevant information regarding
both your tattoo and any other medical conditions
from which you suffer.
During the healing process, the treated
area might feel itchy, but you must resist
scratching because it may lead to infection
and scarring of the treated area.
The normal interval between treatments is
8 weeks to allow sufficient time for the
skin to heal and the treatment to be most
effective.
I recommend that you use a moisturising
cream on the treated area between treatments.
Suitable eye protection is essential so
that your eyes are kept safe from the laser.
The possibility of scarring is increased
in areas where the tattoo ink is particularly
dense. There is a risk that the natural
pigment in the skin may increase or decrease
as a result of treatment, and this may be
permanent, but equally, increased or decreased
pigmentation may resolve after six months
but cannot be guaranteed and sometimes a
“ghost” of your tattoo may remain
on the skin, because the skin where the
tattoo once was remains paler than the skin
surrounding it.
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Removing
brown pigmented skin blemishes
IPL of a suitable wavelength for absorption
by the melanin contained within freckles
and sun (also called liver) spots, can be
used to decrease or remove these skin blemishes.
IPL uses heat energy to damage the blemishes
whilst causing minimal damage to the surrounding
skin. Following treatment, the damaged lesions
turn darker first, and may crust, and then
over a period of weeks they will gradually
flake away from the skin leaving little
trace of the original mark.
Back to top
How
is the treatment carried out?
A thin layer of gel is applied to the skin
being treated after first cooling it with
a stream of refrigerated air. This helps
to cool the skin, as well as ensuring optimal
transmission of light from the applicator
to the skin.
Your first treatment will occur at the end
of your consultation, and will consist of
several treatment “test patches”
which will allow me to assess the response
of the blemish to the treatment and to ascertain
at which power to treat your blemish subsequently.
During treatment you must wear protective
eye goggles.
Back to top
Who
can be treated?
Almost everyone can be treated, apart from
very dark skinned or tanned individuals.
Not all pigmented lesions can be treated.
Large, dark moles should not be treated,
nor should lesions covering a large part
of the body. The pigmented marks that
respond the best are superficial lesions
such as those caused by sun damage (sun
spots) and freckles.
It is important that these treatments are
carried out only on pigmented blemishes
which have a negligible risk of cancerous
change and so you should ensure that you
are either treated by someone who is medically
qualified and has the expertise to assess
these blemishes, or that you have had an
examination by an expert first. I
am a Consultant Plastic Surgeon with a special
expertise in melanoma and other skin cancers,
working in partnership with Dermatologists
and Oncologists in a regional centre for
these cancers. I will always assess
your skin clinically before considering
any treatment.
Back to top
Will
it hurt me?
As the light energy is absorbed in the skin,
it heats it up, and creates a sharp sensation
like a hot pinprick. Most patients
describe the discomfort as moderate and
acceptable. No anaesthesia is required,
but to ease the discomfort I use a cold
gel for IPL treatment in combination with
a refrigerated air jet that you control
during your treatment.
Back to top
What
should I expect after the treatment?
Redness and a slight burning sensation are
normal after treatment. A cooling
pack will be applied to the skin to ease
these symptoms. The lesions will darken
after treatment and may appear more obvious
at first, but gradually the marks will flake
away. However, if you expose yourself
to sunlight you may get a recurrence of
the original mark, so you should always
wear a sunscreen with a SPF of 15 or higher.
Back to top
What
are the side effects?
The visible light used in IPL is completely
safe so no special precautions are needed
apart from wearing protective glasses during
treatment.
The skin of some patients becomes quite
red immediately after treatment and in rare
cases some bruising may be seen. However,
most patients experience no side effects
and any redness or bruising usually disappears
over a period of hours to a few days.
Very rarely the natural pigment in the skin
may increase or decrease as a result of
treatment, and this may be permanent.
If you have been exposed to sun, a day or
so before treatment and have not yet developed
a tan, you may still have enough extra melanin
in your skin to burn, and then your skin
will blister and scab after treatment and
this may scar ultimately ' so avoidance
of the sun and tanning before treatment
is vital.
Back to top
How
do I prepare for treatment?
You must avoid the sun, or using either
a tanning salon or any fake tan for 6 weeks
before or during the entire treatment period
to avoid burns from light absorption in
the epidermis.
Also, immediately after the treatment, the
skin is particularly sensitive to UV light,
and strong sunlight should be avoided for
1-2 weeks.
Back to top
How
long does treatment take?
The length of each treatment will depend
on the type and size of lesion present,
but a typical session for Rosacea might
take 15 - 30 minutes.
Back to top
How
many treatments are necessary?
The length and number of treatments will
depend on the type and size of lesion present,
but typically 1-5 treatments will be needed.
Treatments should take place approximately
every 4 - 6 weeks.
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Acne
Treatment
IPL treats acne using yellow, green and
red light. The yellow light destroys the
bacteria that live in the skin and cause
acne, while the red light targets the overactive
sebaceous glands directly so lessening outbreaks
of pustules.
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How
is the treatment carried out?
A thin layer of gel is applied to the skin
being treated after first cooling it with
a stream of refrigerated air. This helps
to cool the skin, as well as ensuring optimal
transmission of light from the applicator
to the skin.
Your first treatment will occur at the end
of your consultation, and will consist of
several treatment “test patches”
which will allow me to assess the response
of the blemish to the treatment and to ascertain
at which power to treat your blemish subsequently.
During treatment you must wear protective
eye goggles.
Back
to top
Who can be treated?
Almost everyone can be treated, apart from
very dark skinned or tanned individuals.
People with mild to severe acne should see
an improvement.
Pregnant women or people taking the acne
treatment Roaccutane should not be treated.
Back to top
Will
it hurt me?
As the light energy is absorbed in the skin,
it heats it up, and creates a sharp sensation
like a hot pinprick. Most patients
describe the discomfort as moderate and
acceptable. No anaesthesia is required,
but to ease the discomfort I use a cold
gel for IPL treatment in combination with
a refrigerated air jet that you control
during your treatment.
Back to top
What
should I expect after the treatment?
Redness and a slight burning sensation are
normal after treatment ' this generally
dies down within 30 minutes, but some people
remain red for up to 24 hours. A cooling
pack will be applied to the skin to ease
these symptoms. The lesions will darken
after treatment and may appear more obvious
at first, but gradually the marks will flake
away. However, you should avoid sun
exposure and wear a sunscreen with a SPF
of 15 or higher for 2 weeks after treatment.
Back to top
What
are the side effects?
The visible light used in IPL is completely
safe so no special precautions are needed
apart from wearing protective glasses during
treatment.
The skin of some patients becomes quite
red immediately after treatment and in rare
cases some bruising may be seen. However,
most patients experience no side effects
and any redness or bruising usually disappears
over a period of hours to a few days.
Very rarely the natural pigment in the skin
may increase or decrease as a result of
treatment, and this may be permanent.
If you have been exposed to sun a day or
so before treatment and have not yet developed
a tan, you may still have enough extra melanin
in your skin to burn, and then your skin
will blister and scab after treatment and
this may scar ultimately ' so avoidance
of the sun and tanning before treatment
is vital.
It is possible that some hair loss will
occur, and it could be permanent, so men
should consider this possibility before
agreeing to treatment of their beard area.
There are some positive side effects as
well as acne reduction, many people find
that their skin texture and tone improve
dramatically.
Back to top
How
do I prepare for treatment?
You must avoid the sun, or using either
a tanning salon or any fake tan for 6 weeks
before or during the entire treatment period
to avoid burns from light absorption in
the epidermis.
Also, immediately after the treatment, the
skin is particularly sensitive to UV light,
and strong sunlight should be avoided for
2-3 weeks.
Back to top
How
long does treatment take?
A typical treatment session will last 15
- 45 minutes.
Back to top
How
many treatments are necessary?
The number of treatments necessary varies
from person to person, but typically 1-5
treatments will be needed to get a lasting
result, and each treatment should have an
interval between it and the next of 2 -
4 weeks.
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Combined
Facial Therapy
This is a skin
rejuvenation treatment that combines
a skin peel with IPL of a suitable wavelength
and power to produce very mild, reversible,
thermal damage to the epidermis. When the
body repairs this damage subsequently, the
rate of production of collagen in the dermis
of the skin is increased which, to a variable
degree, effaces fine lines and wrinkles
and improves the appearance and texture
of your skin. It may also improve
your complexion and make the pigmentation
of your skin more uniform.
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How
is the treatment carried out?
The skin is thoroughly cleansed, and then
a mild, relaxing skin peel is
applied and left on the face for 5 - 8 minutes.
The peel is then removed, along with the
top layers of dead skin, leaving the skin
feeling smoother and refreshed. The
skin is then cleansed again and a cool,
soothing gel is applied to the face.
The gel also ensures optimal transmission
of the IPL to the skin.
The IPL is pulsed through the skin, after
which the skin is cleansed and moisturised.
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Who
can be treated?
The ideal patient is fair skinned but darker
skin types can derive benefit too.
If there are any areas of broken skin, the
treatment should be delayed until the area
has completely healed.
Will
it hurt me?
As the light energy is absorbed in the skin,
it heats it up, and creates a sharp sensation
like a hot pinprick. Most patients
describe the discomfort as moderate and
acceptable. No anaesthesia is required,
but to ease the discomfort I use a cold
gel for IPL treatment in combination with
a refrigerated air jet that you control
during your treatment.
What
are the side effects?
The visible light used in IPL is completely
safe so no special precautions are needed
apart from wearing protective glasses during
treatment.
The skin of some patients becomes quite
red immediately after treatment and in rare
cases some bruising may be seen. However,
most patients experience no side effects
and any redness or bruising usually disappears
over a period of hours to a few days.
Very rarely the natural pigment in the skin
may increase or decrease as a result of
treatment, and this may be permanent.
If you have been exposed to sun a day or
so before treatment and have not yet developed
a tan, you may still have enough extra melanin
in your skin to burn, and then your skin
will blister and scab after treatment and
this may scar ultimately, so avoidance
of the sun and tanning before treatment
is vital.
It is possible that some hair loss will
occur, and it could be permanent, so men
should consider this possibility before
agreeing to treatment of their beard area.
Back to top
How
do I prepare for treatment?
You must avoid the sun, or using either
a tanning salon or any fake tan for 6 weeks
before or during the entire treatment period
to avoid burns from light absorption in
the epidermis.
Also, immediately after the treatment, the
skin is particularly sensitive to UV light,
and strong sunlight should be avoided for
2-3 weeks.
How
long does treatment take?
A facial treatment, with skin peel, usually
takes about 30 minutes
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How
many treatments are necessary?
Treatment sessions are recommended every
2-3 weeks. The actual number of sessions
needed varies from person to person, but
usually about 6 treatments are sufficient,
with top-up sessions as required.
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