This book represents the collective experience of the Laser & Skin Surgery Center of New York, arguably one of the largest and most comprehensive private laser and technology centers in the world. Our physicians as the primary authors of each chapter are all fellowship trained in procedural dermatology and have been active in the clinical development of many of the devices you will be reading about in this book. It is my hope that this experience will help the reader understand the science and the rationale for the clinical use of each of the devices and the conditions for which their use is indicated.
My interest in lasers began as a senior resident in dermatology at the New York University Medical Center Skin & Cancer Unit in 1983. At that point I established the Department of Dermatology’s laser program. I began with 2 lasers that are now essentially defunct, the argon and continuous-wave carbon dioxide lasers. By today’s standards our results from those lasers were marginal and grossly inferior to what can be achieved with current technologies.
The field of lasers was transformed in 1994 with the introduction of the theory of selective photothermolysis allowing for the selective destruction of a vascular target in the skin (Chapter 1). I was fortunate to have been involved in the clinical trials of the first of the lasers (pulsed dye) that was developed in accordance with the selective photothermolysis theory. As the forerunner of the long and growing list of lasers capable of selective injury, the pulsed dye laser was initially designed and developed for the safe treatment of port-wine stains and has subsequently been utilized as an effective treatment for many additional vascular conditions, scars, and numerous inflammatory conditions (Chapter 2). In 1990 and 1991 selective photothermolysis of pigment including tattoo pigment was introduced with the Q-switched ruby and Nd:YAG lasers and subsequently with the Q-switched alexandrite lasers (Chapter 3). The ability to safely and effectively remove tattoos and many types of epidermal and dermal pigmentation helped the concept of laser technology gain broader acceptance in the dermatologic community. These lasers were further modified in the later part of the 1990s with longer pulse widths for the removal of hair, which has experienced worldwide popularity (Chapter 4). Rejuvenation of the skin and the removal of neoplasms were promulgated in the mid-1990s with the use of sophisticated scanning and delivery systems for the ablative carbon dioxide laser. While in theory the SP concept would apply to the absorption of water allowing for precise thermal injury of the skin, extraordinary results were by thermal side effects with higher than expected incidence of depigmentation and scarring allowing this resurfacing procedure to lose popularity.
Fortunately, in the early 2000s the concept of fractional resurfacing was introduced, addressing many of the concerns of prolonged healing and untoward side effects. Initially as a nonablative procedure and subsequently as an ablative rejuvenation technique, effective and safe resurfacing has become a viable option for a broad segment of the public (Chapter 5). The first decade of this century also brought about the introduction of non-laser technologies including monopolar and bipolar radio frequency, focused ultrasound, low-level light, and the use of cold for therapeutic purposes. This broad range of energy devices has further expanded the options for resurfacing and has provided unique nonablative options for skin tightening and body contouring (Chapter 6). The past decade or so has also seen the modification of wavelengths and techniques to allow for the safe and effective treatment of the skin of color as well as the treatment of inflammatory diseases such as acne (Chapter 7) and precancerous lesions in combination with light or lasers (Chapter 8). The use of laser technology for traumatic, surgical, and acne scars has been well accepted by a population of patients with limited therapeutic options (Chapter 9).
The future of lasers and light sources may well be exemplified by the introduction of home-based devices for hair removal, acne, and rejuvenation (Chapter 10).
This book was intended to give a broad overview and update on the range of technologies offered as of 2013. While this didactic review is intended to provide physicians and their professional staff the background required to appreciate the use of technology for the skin, it will not replace the need for an understanding of skin biology and hands-on training and experience.
The enclosed DVD should embellish the didactic content of what has been written.
This book and the accompanying DVD should be considered part of an ongoing learning experience as this is a rapidly changing field that will continue to evolve at a rapid pace with increasing importance in field of dermatologic care.