Laser (non-ablative) Treatment for Pigmentation

 

Description:

Laser treatment for pigmentation is comfortable, effective with minimal to zero recovery time. The actual laser therapy takes 10 minutes to complete. 

 Indications:

Pigmentation such as melasma, solar lentigine, freckles, dark eye circles.

Brightening dull complexion & uneven skin tone.

Collagen production stimulation and rejuvenation

Open pores and fine lines

Acne & black heads

Treatment procedure:

30 minutes of numb cream on treatment area

Laser treatment of 10 minutes by Dr. Kent

Optional post-laser medical facial: cooling and direct delivery of vitamins, growth factors, peptides, anti-oxidants, moisture, whitening active ingredients into skin cells to boost laser effect & strengthen overall skin wellness (15 minutes)

Choice of hydrating, whitening, desensitizing, re-energizing and purifying mask for 15 minutes

Downtime:

None. For some individual, skin may turn mildly pinkish for a few minutes to hours.

Treatment interval:

Once every 3-4 weeks. Once desired effect achieved, interval can be increased to 2 – 3 months.

Myth buster: 

This laser does not make your skin thinner; in fact, it makes your skin healthier and cleaner over time. It does not make your skin more sensitive. This laser is different from IPL (intense pulse light) which is a broad spectrum light therapy. IPL is not a laser and it can only reach the superficial epidermis of the skin. Hence, it is not the treatment of choice for deep (dermal) pigmentation such as melasma on Asian skin.

 Pre-Care Instructions:

CONTRAINDICATIONS to treatment: history of melanoma, suspicious lesions, healing problems, active infections, open lesions, tattoos or permanent make-up in area of treatment, autoimmune diseases such as Lupus, Scleroderma, Vitiligo, pregnancy. Do not tan or use self tanner in areas to be treated for 4 weeks prior. Avoid any irritant chemical for the week prior.

Post-Care Instructions:

Mild redness may appear on the first day. A small number of individuals may develop urticaria with mild itchiness and few tiny red bumps after the treatment or on the next day. Notify Dr. Kent if this happens as it can be resolved within 24 hours with oral anti-histamine tablet. Urticaria can also be prevented by taking a tablet of anti-histamine just before the laser therapy. Keep area moist and clean and always apply daily sunscreen of minimum SPF50. We recommend Kent's range of skincare: Nourishing Cleanser, Soothing Essence, Brightening Night Lotion, Whitening Cream, Anti-oxidant Rejuvenation Cream, 15% Vitamin C Essence, Rejuvenating Eye Serum/Cream, Sunscreen SPF50 with Matifying or Glowing Finish, Brightening Face Mask and/or Hydrating Face Mask. Gently cleanse the area twice daily with gentle cleanser. Avoid irritants (glycolics acid, salicyclic acid, retinoids, hydroquinone) until redness fully resolves. Apply sunscreen daily or better yet twice daily. Second application is between 11am to 3pm after dab-drying sweat or sebum on face. Avoid sauna/steam bath or prolonged sun-exposure (continuous 1 hour or more) on the same day. Make-up may be used as long as skin is not broken or irritated.

Notify Dr. Kent if you have any questions, concerns, problems. DR KENT CLINIC contact: 0380523082, 0374978788 , 0123954223, 0122211841.

 

Updated info on novel treatment of pigmented lesions:

New Technologies Show Promise for Treating Pigmented Lesions

October 16, 2020

Picosecond and nanosecond lasers are far more effective for treating individual lentigines, compared with other types of devices, but ultrashort pulses carry a higher risk for postinflammatory hyperpigmentation than intense pulsed light or the long-pulsed laser, according to Mathew M. Avram, MD, JD.

For treating melanosomes with selective photothermolysis, some of the peak wavelengths include 532 nm, 694 nm, 755 nm, and 1064 nm, Avram, director of laser, cosmetics, and dermatologic surgery at Massachusetts General Hospital, Boston, said during the virtual annual Masters of Aesthetics Symposium. "The ideal target is fair skin with a dark, pigmented lesion," he said. "That way you're going to get energy focused to the melanin that's in the lesion itself."

Q-switched and picosecond lasers are effective for pigmented lesions. These employ as much energy as the city of Boston for 20-30 billionths of a second, or 750 picoseconds. "This raises the temperature to 1,000° C in that time, which produces the characteristic epidermal whitening," he said. "This targets pigment cells only, whether it's exogenous or endogenous pigment."

Benign pigmented lesions amenable to the Q-switched nanosecond and picosecond laser include lentigines and nevus of Ota/Ito. The mechanism of action for clinical lightening is fragmentation and release of melanin-laden cells and the gradual uptake and removal of fragments by activated macrophages into lymphatic vessels. "For effective results, do not blindly memorize settings or replicate recommended settings from a colleague or a device manufacturer," advised Avram, who practiced law prior to becoming a physician. "Some lasers are not externally calibrated, so what you have to do is pay attention to the laser endpoint, which in this case is epidermal whitening. Tissue 'splatter' is an unsafe endpoint and may lead to scarring. Safe and unsafe laser endpoints and close clinical observation are the best means to avoid complications and get the best results for your patients. The key finding is the endpoint, not the energy settings."

 

Pigmented lesions that should not be treated with a laser include atypical nevi, lentigo maligna, and other forms of melanoma. "When in doubt, perform a biopsy," he said. "Regardless of who referred the case, you are liable if you treat a melanoma with a laser. This is not only misdiagnosis but it probably delays diagnosis as well. If you cannot recognize basis pigmented lesion morphology, do not treat pigmented lesions. At some point, it's going to catch up with you."

Patients with more pigment to their skin face a higher risk for postinflammatory hyperpigmentation, Avram continued. While longer pulsed lasers produce less hyperpigmentation, they're also less effective at getting rid of lesions. "You can combine a long-pulsed laser with fractional resurfacing or IPL [intense pulsed light] to optimize improvement," he said. "If you don't have two lasers to use, you can just use a longer-pulsed laser. The desired treatment endpoint for this approach is an ashen gray appearance." Options include a 532-nm Nd:YAG laser with or without cooling, a 595-nm pulsed dye laser without cooling, and a 755-nm alexandrite laser without cooling.

One advance in the treatment of seborrheic keratoses is Nano-Pulse Stimulation (NPS), a novel technology being developed by Pulse Biosciences. With this approach, nanosecond electrical energy pulses cause internal organelle disruption, which leads to regulated cell death. "The cell-specific effect is nonthermal, as a typical nano-pulse delivers 0.1 joules of energy distributed in a volume of tissue," Avram said. Early human studies established safe doses and validation of mechanism hypothesis for benign-lesion efficacy. "What you have are tiny nanopores that allow calcium ions to flow into the cell," he explained. "The nanopores in the endoplasmic reticulum allow calcium ions to flow out of the endoplasmic reticulum, stressing it. These nanopores in the mitochondria disrupt the ability to generate energy, and the cell dies."

Histology has revealed that within days the procedure causes regulated cell death with no thermal effects. The ability of NPS energy to clear seborrheic keratoses (SK) was confirmed in a study of 58 subjects who had 174 SK lesions treated. The majority of SKs (82%) were rated as clear or mostly clear 106 days post treatment. All results reflected a single treatment session.

Another novel treatment, "cryomodulation," a technology being developed by R. Rox Anderson, MDDieter Manstein, MD, PhD, and Henry Chan, MD, PhD, expresses cold-induced change to the skin as a way to pause melanin production. "You get melanin production paused but melanocyte function is preserved," Avram explained. "There is a normal epidermal barrier and no persistent inflammatory response, so there's no hyperpigmentation." He characterized it as an ease-of-use clinical procedure for treating benign lesions in all skin types. A mask is applied to confine freezing to the desired treatment area, and hydrated gauze is used to help facilitate ice crystal propagation. A prototype of the device features a parameter selection based on lesion type, anatomical location, and skin type. "It uses between 107 and 166 kJ/m2 of extracted energy, and you take photos at baseline and follow-up," he said. "You get 2-3 days of redness, darkening, and swelling. It's well tolerated, with minimal discomfort. There's no long-term dyschromia. This is nice, because patients have little, if any, downtime."

 

Avram disclosed that he has received consulting fees from Allergan, Merz, Sciton, and Soliton. He also reported having ownership and/or shareholder interest in Cytrellis.

 


 

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