47
Introduction to Lasers in Dermatology Kristen Kelly, M.D. Clinical Professor of Dermatology and Surgery Beckman Laser Institute and Medical Clinic University of California, Irvine

Introduction to Lasers in Dermatology · Introduction to Lasers in Dermatology Kristen Kelly, ... •Ophthalmology . ... Lasers for Hair Removal

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Introduction to Lasers

in Dermatology

Kristen Kelly MD

Clinical Professor of

Dermatology and Surgery

Beckman Laser Institute and

Medical Clinic

University of California Irvine

bull Please no photos during the presentation

bull Patient privacy needs to be protected

Lasers Applications in Medicine

bull Dermatology

ndash Blood vessel lesions

ndash Pigmented (Brown)

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Lasers Applications in Medicine

bull Neurosurgery

bull Podiatry

bull General Surgery

bull Gynecology

bull Ophthalmology

Laser Effect on Biological Tissue

bull Depends on tissue properties

bull Function of laser parameters

bull Details are not fully understood

Tissue Propertiesoptical thermal mechanical

light distribution

heat transfer

stress propagation

Laser Parameters Things a surgeon can control

Wavelength

Determines penetration depth

ldquotargets chromophorerdquo

Pulse Duration

How long the tissue is heated

Power

Energy depositionHeating rate

Use of Epidermal Cooling

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

bull Please no photos during the presentation

bull Patient privacy needs to be protected

Lasers Applications in Medicine

bull Dermatology

ndash Blood vessel lesions

ndash Pigmented (Brown)

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Lasers Applications in Medicine

bull Neurosurgery

bull Podiatry

bull General Surgery

bull Gynecology

bull Ophthalmology

Laser Effect on Biological Tissue

bull Depends on tissue properties

bull Function of laser parameters

bull Details are not fully understood

Tissue Propertiesoptical thermal mechanical

light distribution

heat transfer

stress propagation

Laser Parameters Things a surgeon can control

Wavelength

Determines penetration depth

ldquotargets chromophorerdquo

Pulse Duration

How long the tissue is heated

Power

Energy depositionHeating rate

Use of Epidermal Cooling

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Lasers Applications in Medicine

bull Dermatology

ndash Blood vessel lesions

ndash Pigmented (Brown)

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Lasers Applications in Medicine

bull Neurosurgery

bull Podiatry

bull General Surgery

bull Gynecology

bull Ophthalmology

Laser Effect on Biological Tissue

bull Depends on tissue properties

bull Function of laser parameters

bull Details are not fully understood

Tissue Propertiesoptical thermal mechanical

light distribution

heat transfer

stress propagation

Laser Parameters Things a surgeon can control

Wavelength

Determines penetration depth

ldquotargets chromophorerdquo

Pulse Duration

How long the tissue is heated

Power

Energy depositionHeating rate

Use of Epidermal Cooling

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Lasers Applications in Medicine

bull Neurosurgery

bull Podiatry

bull General Surgery

bull Gynecology

bull Ophthalmology

Laser Effect on Biological Tissue

bull Depends on tissue properties

bull Function of laser parameters

bull Details are not fully understood

Tissue Propertiesoptical thermal mechanical

light distribution

heat transfer

stress propagation

Laser Parameters Things a surgeon can control

Wavelength

Determines penetration depth

ldquotargets chromophorerdquo

Pulse Duration

How long the tissue is heated

Power

Energy depositionHeating rate

Use of Epidermal Cooling

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Effect on Biological Tissue

bull Depends on tissue properties

bull Function of laser parameters

bull Details are not fully understood

Tissue Propertiesoptical thermal mechanical

light distribution

heat transfer

stress propagation

Laser Parameters Things a surgeon can control

Wavelength

Determines penetration depth

ldquotargets chromophorerdquo

Pulse Duration

How long the tissue is heated

Power

Energy depositionHeating rate

Use of Epidermal Cooling

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Tissue Propertiesoptical thermal mechanical

light distribution

heat transfer

stress propagation

Laser Parameters Things a surgeon can control

Wavelength

Determines penetration depth

ldquotargets chromophorerdquo

Pulse Duration

How long the tissue is heated

Power

Energy depositionHeating rate

Use of Epidermal Cooling

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Parameters Things a surgeon can control

Wavelength

Determines penetration depth

ldquotargets chromophorerdquo

Pulse Duration

How long the tissue is heated

Power

Energy depositionHeating rate

Use of Epidermal Cooling

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Objective of Laser Skin Surgery

Target a selected light absorbing

chromophore in human skin without

damaging surrounding tissue

Epidermis

Dermis

Targeted

Chromophores

Melanin

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Early Therapeutic Use of Lasers

bull Blood vessel lesion improvement

bull Significant incidence of scarring

especially in young children

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Theory of Selective Photothermolysis

bull Laser energy preferentially absorbed by

one structure in tissue

ndash Melanin dermis blood tattoo ink etc

bull Surrounding tissue has low absorption

bull Selective absorption of radiant energy

bull Selective heatingdestruction of tissue

Anderson R Parrish J Science 1983 220524-527

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

only chromophores

absorb light

selective

photothermal

lysis

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Theory of Selective Photothermolysis

bull Two parameters central to this concept

ndashWavelength

ndashPulse Duration Anderson R Parrish J Science 1983 220524-527

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Wavelength

bull Laser wavelength must

approximate an absorption peak of

the targeted chromophore in

relation to other optically absorbing

molecules

bull Wavelength also determines the

depth to which light penetrates with

sufficient energy to effect tissue

change

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Selective Photothermolysis

bull Pulse duration should be on the

order of the thermal relaxation time

(TRT) of the target

bull Thermal relaxation time is the

duration required for the heat

generated by absorbed light energy

within the target chromophore to

dissipate to 50 of its value

immediately after laser exposure

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Thermal Relaxation Time

bull Directly related to the size of the target

bull Inversely related to heat diffusion

of the tissue

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

microvessel

blood vessel

10 m

200 m

90 s

5 ms

tattoo

pigment

05-100

m 20 ns-3 ms

melanosome

melanocyte

05-10 m

7 m

20-40 ns

1 s

Target Size r

Target Chromophore Size and r

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Pulse Duration of Commercially

Available Pulsed Dye Lasers

bull 450 microseconds

bull 1500 microseconds

bull 1500-40000

microseconds

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Longer Pulse Durations

-Allow gentler heating of target

-Avoiding mechanical disruption of vessel and

purpura

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Selective photothermolysis significantly

improved treatment outcome

However challenges remained

Multiple treatments required

Incomplete lesion removal

Treatment of darker skin types

Treatment discomfort

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Problem Nonspecific epidermal (melanin) absorption

Answer Epidermal Cooling

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Chromophores in human skin - absorption spectra

of hemoglobin melanin and water

Ru

by

Nd

YA

G

514

532 694 1064

Arg

on

KT

P

Pu

lse

d

Dye

Ale

xa

nd

rite

755

Ca

rbo

n

dio

xid

e

10600

Wavelength (nm)

500 1000 3000

Hemoglobin

Melanin Water

5000 10000 E

rY

AG

2940 577

595

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Cooling the Superficial Skin Layers

Target

Chromophores

Epidermal

Melanin

Cooling Medium

Dermis

Epidermis Epidermis

Dermis

Prevents epidermal injury

Leaves the dermal target susceptible

to laser induced thermal injury

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Cryogen Spray Cooling Device

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Contact Cooling Devices

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Air Cooling Device

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Epidermal Cooling

- Allows the use of higher fluences

- Allows safe treatment of darker skin

- Decreases treatment discomfort

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Lasers Applications in Medicine

bull Dermatology

ndash Vascular lesions

ndash Select Pigmented

Lesions

ndash Tattoos

ndash Laser Hair Removal

ndash Skin Resurfacing

ndash Skin Rejuvenation

ndash Acne

ndash Vitiligo

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Treatment of

Vascular Skin Lesions

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Treatment of Vasculature

bull Chromophore Oxyhemoglobin (blood)

bull Pulse Duration Variable (1-10 milliseconds)

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Immediate blood vessel hemorrhage after

pulsed dye laser treatment in an animal model

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Treatment of

Pigmented Lesions

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Treatment of

Pigmented Lesions

bull Chromophore Melanin

bull Pulse Duration Very Short (Q-switched)

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Tattoo Removal

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Tattoo Removal

bull Target Chromophore Tattoo pigment

bull Pulse Duration Very Short (Q-switched)

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Zelickson BD Mehregan DA Zarrin AA et al Clinical Histologic

and Ultrastructural Evaluation of Tattoos Treated with Three Laser

Systems Lasers Surg Med 1994 364-372

bullPhotothermal and Photoacoustic

bullWavelength selection based on color

bullShock waves break up tattoo dye and

then blood cells clear away

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Hair Removal

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Lasers for Hair Removal

Ruby Laser (l = 694 nm)

Alexandrite Laser (l = 755 nm)

Diode Laser (l = 800 nm)

Long Pulsed NdYAG Laser (l =1064 nm)

Pulsed Filtered Flashlamp (l = 590 - 1200 nm)

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Hair Removal

bull Target Chromophore Hair Shaft Melanin

bull Pulse Duration Long ( 20-50

milliseconds)

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

J Am Acad Dermatol 2006 Sep55(3)402-7 Epub 2006 May 26

The effects of laser-mediated hair removal on immunohistochemical staining properties of hair follicles

Orringer JS Hammerberg C Lowe L Kang S Johnson TM Hamilton T Voorhees JJ Fisher GJ

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Laser Skin Resurfacing

bull CO2 and ErYAG lasers

bull Target tissue water

bull Tissue ablation

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Formation of New Collagen

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Ablative Non-ablative Fractional Photothermolysis

Manstein D Herron GS Sink RK Tanner H Anderson RR

Fractional photothermolysis a new concept for cutaneous

remodeling using microscopic patterns of thermal injury

Lasers Surg Med 200434(5)426-38

Methods to induce collagen remodeling

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Photodynamic Therapy (PDT)

bull PDT is a drug-device

combination

bull The topical drug is

activated by appropriate

light

bull Requires

ndash Photosensitizer

ndash Light

ndash Oxygen

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

- ALA is applied topically to the skin and converts to

Protoporphyrin IX a naturally-occuring powerful

photosensitizer

- ALA is preferentially absorbed by fast-growing cells

eg AKrsquos sebaceous glands sun-damaged cells

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

PDT

bull Photosensitizer is

applied to desired

treatment areas

bull Wait

bull Photosensitizer

washed off

bull Laser or light source

treatment

bull Photoprotection

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture

Beckman Laser Institute

BLI

QuickTimetrade and aTIFF (Uncompressed) decompressor

are needed to see this picture