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- WHAT IS ND: YAG LASER?
- HOW DOES ND: YAG LASER WORK?
- WHAT IS ND: YAG LASER USED FOR?
- WHAT DOES THE LASER PROCEDURE INVOLVE?
Nd:YAG (neodymium-doped yttrium aluminium garnet) is a crystal that is used as a laser medium for solid-state lasers.
The triply ionised neodymium [Nd(III)] dopant (ie a substance added in minute amounts to another pure substance to alter its conductivity), typically replaces a small fraction of the yttrium ions in the host crystal structure, since the two ions are of similar size.
The neodymium ion provides the laser activity in the crystal.
Nd:YAG laser has a wave length of 1064 nm and has the capability to reach deeper layers of skin tissue than other types of lasers.
In Q-switched mode, Nd:YAG produces 2 wavelengths, one in the infrared range (1064 nm) and a second beam of 532 nm wavelength which is useful for superficial skin lesions. Q-switching refers to the technique of making the laser produce a high intensity beam in very short pulses
Lasers work by emitting a wavelength of high energy light, which when focused on a certain skin condition will create heat and destroy diseased cells.
Most pigmentary skin lesions, whether epidermal or dermal, acquired or congenital, can be treated with Q-switched lasers of blue, green, and infrared light. Though the clinical indications of a Q-switched NdYAG laser are numerous, a few are listed below:
While the epidermal lesions respond best to 532 nm (frequency doubled NdYAG) the dermal lesions are better treated with 1064 nm. Q-switched lasers are the gold standard for treatment of tattoos
- Lentigines: usually 1-2 sessions are enough to clear lentigines at 532 nm. However there is a risk of hypo/ hyperpigmentation, so avoidance of sun exposure for 4-6 weeks post laser is very important.
- CafÈ-au lait macules: these again can be treated effectively in 1-2 sessions, but recurrence is common which requires multiple treatments.
- Freckles: Response is same as for lentigines. Although very effective, risk of dyspigmentation exists.
- Dermal pigmented lesions: Nevus of Ota, Nevus of Ito, mongolian spots, Horiís nevus, ABNOMs (acquired bilateral nevus of Ota like macules), and other flat pigmented birthmarks respond well at 1064 nm. Multiple sessions are usually required with near-total clearing of the lesion in most cases.
- Light pulses target melanin at variable depth on or in the skin.
Medium depth nonablative skin resurfacing
Frequency doubled 532 nm Q switched is a well-established technology for treating photoaging. When used at lower fluences with a larger spot size, it is a medium depth laser peel, with less downtime and high patient satisfaction. However, due to the risk of postinflammatory pigmentary changes in Indian skins, it should be used only after a test patch and adequate sun protection advised to the patient.
High-energy pigmented selective laser, for example, 694 nm, Q-switched ruby laser, 755 nm Q-switched alexandrite laser, 532 nm frequency doubled Q-switched NdYAG laser, and 1064 nm Q-switched NdYAG laser had been studied for treatment of melasma with poor results. Normal skin colour was rarely achieved. Epidermal melasma responds better and faster than dermal/mixed melasma. Complete clearing of lesions may be expected in more than 50% cases of epidermal melasma. Complete clearing of dermal/ mixed melasma may be seen in about 30-50% cases, while the remaining cases will show moderate improvement.
Postinflammatory hyperpigmentation and rebound melasma are dreaded complications that may occur in the individual with sensitive skin. Lower energy and fewer repetitions are adequate to produce marked improvement. Improvement will need to be maintained by repeated treatments. However, recurrence is common in melasma.
Though Q-switched ruby and Q-switched alexandrite lasers have been earliest lasers for tattoos, Q-switched NdYAG 1064 nm, due to its longer wavelength, higher fluence, and shorter pulse, has emerged as a better laser for the black and dark blue/ black tattoo pigment. The textural changes, scarring, and hypopigmentation of earlier lasers are remarkably low. However for coloured pigments, use of multiple wavelengths is mandatory. Response to Q-switched 1064 nm depends on the type of tattoo:
- Professional tattoos: Most of such tattoos have even distribution of ink, mainly in subcutaneous tissue. Ink quality is good; hence, 4-6 treatments are usually required.
- Amateur tattoos: Usually these are easy to remove, but in some cases, if the ink is at deeper level, a few extra sessions could be required.
- Cosmetic tattoos: Cosmetic tattoos like eyebrows, and eye and lip line are mostly made of iron-based inks. This can sometimes oxidize and turn black, so a test patch must be given.
Blue, grey and black tattoos can be removed with a Q-switched Nd:YAG laser (1064 nm wavelength).
The colour of the tattoo and the depth of the pigment influence the duration and the outcome of the laser treatment.
Laser treatment involves the selective destruction of ink molecules that are then absorbed by macrophages and eliminated.
Typical settings are pulse duration: 10 nanoseconds, output energy: 300¬500Mj.
Nonablative skin resurfacing for wrinkles and acne scars
Q-switched NdYAG laser 1064 nm offers a new technology that helps treat scars and wrinkles at their root, deep in the skin. Using laser energy that penetrates deeply without injuring the top layer of skin, the deep dermis is stimulated to produce natural collagen and other vital proteins that make up healthy, youthful skin. Painlessly done in less than 20 minutes, youll leave the office with only mild redness that will fade within a few hours. After 3-6 treatments, done at monthly intervals, wrinkles soften and skin gets toned. Hence it is also referred to as laser skin toning. This is a good option for improving acne scars, wrinkles, and stretch marks without complicated procedures and long recovery times.
Laser-assisted hair reduction
Though the long-pulsed lasers are gold standards for the removal of terminal hair, Q-switched laser has been tried with and without topical carbon suspension. Q-switched pulses produce a photomechanical impact on the tissue and also on hair shaft and hair follicle, causing reduction as well as delay in hair growth cycle. Since it is not colour dependent, it can be suited for all skin types, even on tanned skins without fear of pigmentary changes.
Nd:YAG laser may be used for hair removal in any location including underarms, bikini line, face, neck, back, chest and legs.
Nd:YAG laser is generally ineffective for light-coloured (blonde/grey) hair, but effective for treating dark (brown/black) hair in patients of Fitzpatrick types I to III, and perhaps light-coloured type IV skin.
Extreme caution is recommended in tanned or darker-skinned patients, as the laser can also destroy melanin, resulting in white patches of skin (leukoderma).
The longer-pulse (millisecond) 1064-nm Nd:YAG laser system has been shown to be more effective in safely removing hair than has the Q-switched (nanosecond) Nd:YAG system.
Light pulses target the hair follicle, which causes the hair to fall out and minimises further growth. Typical settings employed include pulse durations of 2 to 20 milliseconds and fluences of 10¬40 J/cm2.
Q-Switch lasers has been shown to be effective in treating vascular lesions like telangiectasia, cherry angiomas, and small spider nevi. More than one treatment could be required. However, it can cause purpura which could take up to a week to clear.
ND:YAG can be used to remove spider and thread veins in the face (cheek, temporal region, nasal dorsum, forehead) and legs.
Some vascular birthmarks (capillary vascular malformations)
Varicose veins in the leg
Facial veins (telangiectasis)
Haemangiomas (vascular tumours) in the face and around the mouth
The laser light pulses target red pigment (haemoglobin). Typical settings employed for the treatment of facial veins include a 50 milliseconds pulse duration, and fluence (ie output energy) of 150¬250 J/cm2 (measured in Joules per centimetre squared).
Onychomycosis is a common nail disorder caused by fungal pathogens.
There are significant barriers to treatment with oral and topical antifungals.
Successful treatment of onychomycosis requires antifungal drugs to penetrate the nail plate and nail bed, but this is oftn incomplete with oral and topical agents.
Several laser devices have been granted FDA marketing approval for the treatment of onychomycosis.
The lasers are flashlamp pumped short-pulse Nd:YAG 1064 nm lasers.
These lasers emit 100–3000 microsecond pulses with an energy fluence of 25.5 J/cm2 for a 1 mm spot size.
Dark lips are a common cosmetic concern in India. Two to four sessions of Q-switched 532 nm is an effective treatment for lip lightening.
It is important that the correct diagnosis has been made by the clinician prior to treatment, particularly when pigmented lesions are targeted, to avoid mistreatment of skin cancer such as melanoma.
- The patient must wear eye protection (an opaque covering or goggles) throughout the treatment session.
- Treatment consists of placing a hand piece against the surface of the skin and activating the laser. Many patients describe each pulse feeling like the snapping of a rubber band against the skin.
- Topical anaesthetic may be applied to the area but is not usually necessary.
- Skin surface cooling is applied during all hair removal procedures. Some lasers have built-in cooling devices.
- Immediately following treatment, an ice pack may be applied to soothe the treated area.
- Care should be taken in the first few days following treatment to avoid scrubbing the area, and/or use of abrasive skin cleansers.
- A bandage or patch may help to prevent abrasion of the treated area.
- During the course of treatment patients should protect the area from sun exposure to reduce the risk of postinflammatory pigmentation.
In theory the black carbon particles convert light energy from QS ND:YAG laser beam into heat, causing microdamage to the skin. QS ND:YAG can’t heat up the skin due to its extremely short pulse width.
Carbon assisted Q-Switched ND:YAG may be used for facial skin rejuvenation or hair removal. But recent research found improved skin texture in both groups (with / without carbon assistance) and there was no difference between the two groups.
WHAT IS CARBON/BLACK DOLL FACIAL?
“Carbon Laser Skin Rejuvenation” — as we technically call it, is an adept non invasive and pain-free laser treatment that is great for treating minor skin imperfections and giving skin a glow from within. This laser facial is delivered by a state of the art Q-switched Nd-Yag Laser machine producing short, rapid and high intensity pulses of light with maximum capability for destruction of debris clogged in the pores and upper layers of skin.
During the procedure face is cleansed and a thin layer of carbon lotion (as a photoenhancer) is applied. The laser light is absorbed by the black particles of carbon, which blast off along with the superficial dead layer of skin as laser light moves across the skin. Additionally the laser selectively targets facial imperfections such as enlarged pores, pigmentation, scarring, and rough texture. Pores impacted with oil and dead skin are cleared off and the rejuvenating effect of 1064nm laser causes plumping up of the skin. The whole procedure takes 10-15 minutes and best part is there is no down time you can go back to work or your daily life without any delay.
A short course of 4 – 6 fortnightly sessions can give noticeable brightening of overall complexion, and most people opt to continue with regular sessions to maintain the skin’s clarity.
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