Laser Applications in Cosmetic Surgery
CO₂ Laser
First used in cosmetic surgery in the mid-1960s, the CO₂ laser is a gas molecular laser emitting invisible far-infrared light (10600nm). It is impermeable to water and has low tissue penetration (0.1mm), enabling instant vaporization of tissue.The compact CO2 laser cosmetic device is a commonly used model in China, characterized by its simple structure, small size, light weight, and low cost, making it widely adopted.
Indications Pigmentary Lesions: Pigmentation disorders, pigmented macules, café-au-lait spots, seborrheic keratoses. Vascular Lesions: Subungual hemangiomas, spider angiomas, angiokeratomas.Malignant lesions: Superficial basal cell carcinoma, superficial squamous cell carcinoma, carcinoma in situ, leukoplakia. Others: Cutaneous horns, skin tags, keratoacanthoma, syringoma, various warts. Treatment Methods Defocused irradiation: The laser becomes a weak beam after defocusing, targeting the local lesion.This induces a local warming sensation, enhancing local blood circulation, reducing inflammation, and relieving itching. Each session lasts 15 minutes, using a higher-energy defocused laser scanned back and forth across the skin surface. This can serve as laser skin abrasion therapy, selectively destroying the epidermis and superficial dermis.
Coagulation therapy: Medium-power laser irradiation of the skin lesion causes it to whiten, achieving coagulative denaturation and destroying the pathological tissue.
Vaporization Therapy: Focus the laser beam with a spot size of 0.2–1.0 mm, power of 5–15 W, and distance of 2–4 cm, targeting the lesion to vaporize it. For lesions not protruding above the skin, such as pigmented nevi, laser sweeping can be performed—vaporizing layer by layer and wiping away residual carbonized material with a cotton swab until the lesion is completely removed.For lesions significantly protruding above the skin, vaporize and excise the elevated portion, then remove residual tissue via scanning. Wound Management After Medium-Intensity Laser Treatment Following coagulation or vaporization, the lesion site may exhibit minor exudation and mild erythema. Treatment areas typically do not exceed 1cm × 1cm. For exposed wounds, apply 2% gentian violet solution and maintain local cleanliness and dryness.For wounds on the extremities and trunk, protect the area with small gauze pads or adhesive bandages. For larger treatment areas, change dressings regularly until healing is complete. Ar Laser Argon (Ar) lasers are typical ion lasers, first used in cosmetic and reconstructive surgery in the early 1970s. Ar lasers exhibit excellent tissue penetration, with an average penetration depth exceeding 0.84 mm.The blue-green light (wavelength 488–514 nm) emitted by Ar lasers of various wavelengths exhibits excellent penetration in water and is selectively absorbed by hemoglobin, superficial skin melanin granules, and tattoo pigments. This characteristic enables Ar laser treatment for numerous conditions. Indications
Vascular lesions: Port-wine stains, strawberry hemangiomas, telangiectasia.Vascular inflammatory lesions: Rosacea (erythematous stage), granulomas. Pigmentary lesions: Melanotic lesions, hyperpigmentation disorders, tattoos. Ar Laser Treatment for Port-Wine Stain
Port-wine stain (Portwinespot) involves proliferative and dilated capillaries in the dermal papillary layer with normal epidermis.Ar laser non-invasively penetrates the epidermis into the abnormally dilated capillary network. The laser is selectively absorbed by hemoglobin and converted into heat, causing coagulation and occlusion of dermal capillaries, thereby fading the skin redness.Treatment typically employs continuous output with uniform scanning of the lesion area. Each spot is irradiated for 1–2 seconds until the port-wine stain turns white. Computer-controlled Ar lasers automatically adjust wavelength range and energy density, ensuring uniform scanning speed and consistent action for optimal results.
For pulsed output, the laser is positioned perpendicular to the skin at a distance of 2–4 cm.Each session treats a 5cm × 5cm area or punctate lesions until the skin whitens. Post-treatment, mild local edema may occur with possible blister formation. After swelling subsides, scabbing develops, healing within 2–3 weeks as the scab sheds. The red lesion partially or completely fades, potentially leaving minimal scarring.
He-Ne Laser
The helium-neon laser was the first gas laser developed. It possesses anti-inflammatory, analgesic, anti-infective, wound-healing, tissue metabolism-enhancing, and tissue blood flow-boosting effects.
Facial Wrinkle Reduction: Irradiate facial skin for 5–10 minutes per session. Perform daily or every other day, with 10–15 days constituting one treatment course.
Acne Treatment: Use laser output power <15 mW at a distance of 50–100 cm with localized defocused irradiation. The spot size should cover approximately 4 cm × 5 cm. For extensive acne, divide the area into zones for irradiation.Each area receives 10–15 minutes of treatment daily. One course consists of 10–15 days. Treatment may be repeated. During therapy, combine with Chinese herbal medicine and antibiotics for anti-inflammatory, sebum-reducing, heat-clearing, toxin-eliminating, and blood-circulation-promoting effects. Facial massage and skincare treatments may also be integrated.
Alopecia Areata Treatment Output power: 15–25 mW. Aim the spot onto the affected area for 15–20 minutes per session. Treat daily or every other day. For large areas, divide into zones. One course consists of 10 days, with 3–4 courses possible at one-week intervals. Use defocused irradiation with power above 25 mW for extensive bald patches.
Na-YAG Laser
The neodymium-doped yttrium aluminum garnet (Na-YAG) laser is a solid-state laser. Medically, it is commonly used as a surgical tool to cut vascularized tissue, reducing bleeding. It can also be used for tissue coagulation or vaporization therapy. However, this laser is relatively bulky and is often replaced by smaller CO2 lasers in cosmetic surgery applications.