LASER EQUIPMENT FOR RENEWAL

Laser skin rejuvenation

The first laser (LASER is an abbreviation of EnglishAmplification of light from stimulated radiation emission: amplification of light using stimulated radiationfor cosmetic purposes (in ruby), just 55 years ago, in 1960. Since then, laser cosmetology has been one of the most sought after fields in aesthetic medicine.

Laser devices are used very successfully for waxing, rejuvenation, lifting, removal of blood vessels, age spots, marks, stretch marks, acne after acne, neoplasms, tattoos, for the treatment of vitiligo, psoriasis, acne (acne), adult nails.

Today's review of laser equipment is very specialized: we will acquaint the reader in detail with the equipment for skin rejuvenation.

LASER EQUIPMENT

The laser consists of three main elements:

  • power source (or "pumping" mechanism);
  • working body (active environment);
  • mirror system (optical resonator).

Power sourcecan be an electric discharge, a flash lamp, an arc lamp, another laser, a chemical reaction, etc. , which activate the work environment with their own energy.

Working fluidis ​​the main determinant of the wavelength generated, as well as other properties of the laser (monochrome, coherence, narrow focus). There are hundreds or even thousands of different working bodies, based on which a laser can be built. However, the following working media are most commonly used: liquid (consisting of an organic solvent, for example, methanol, ethanol or ethylene glycol, in which the chemical dyes are dissolved), gases (a mixture of gases, for example: carbon dioxide, argon, krypton or mixtures such as helium-neon lasers; these lasers are most often pumped by electrical discharges), solids (such as crystals and glass; solid material is usually activated by the addition of small amounts of chromium ions, neodymium, erbium or titanium); semiconductors.

So, according to the type of working medium (active medium), lasers are divided into:

  • gas;
  • liquid (in inorganic or organic dyes);
  • metal steam laser;
  • solid (crystals, glass);
  • semiconductor (or diode).

The optical resonator, the simplest form of which is two parallel mirrors, is located around the working body of the laser. The forced radiation of the working fluid is reflected between the mirrors and returned to the working fluid, accumulating energy. The wave can be reflected many times before it comes out. In more complex lasers, four or more mirrors are used, which also form an optical resonator, but with a more complex design.

The quality of production and installation of these mirrors is one of the most important conditions for the quality of a laser system.

Also in the laser system, additional devices can be mounted to obtain various effects, such as rotating mirrors, modulators, filters and absorbers. Their use allows changing the parameters of laser radiation, for example, wavelength, pulse duration, etc.

TECHNICAL PARAMETER OF LASER EQUIPMENT

Laser power settings:

  1. Power, measured in watts (W).
  2. Energy, measured in joules (J).
  3. Energy density (J / cm2).
  4. Pulse duration, measured in milli-, nano-, picoseconds.
  5. Wavelength, measured in micrometers (μm) and nanometers (nm).

Laser radiation, which acts on a living organism, is subject to the phenomena of reflection, absorption, scattering. The degree of these processes depends on the condition of the skin: moisture, pigmentation, blood circulation, swelling of the skin and underlying tissues.

Many lasers target specific chromophores, which are biological structures that have a well-defined absorption spectrum. The ability of a particular chromophore to absorb light of different wavelengths with different intensities is determined by the absorption spectrum. The unit of measurement for the ability of a chromophore to absorb laser light is the absorption coefficient.

The absorption spectra of different chromophores vary radically. Therefore, it is important that the wavelength of the laser radiation coincides with the wavelength at the peak of the absorption capacity of the chromophore that is planned to be exposed.

Therefore, there is no universal wavelength, ie a laser, for all indications (appointments). So a laser for hair removal can not renew the skin, and vice versa. Of course, quite often it happens that some goals are indicated in the laser instructions, but in fact there will only be one problem that effectively solves such devices.

The penetration depth of the laser radiation is inversely proportional to the absorption coefficient and, consequently, depends on the wavelength. For different skin chromophores (water, melanin, hemoglobin, oxyhemoglobin), the depth of penetration is also different. For example, in the visible region (0, 38-0, 74 microns, or 380-740 nm), the penetration depth will be 3-7 mm, in the infrared region (0, 76-1, 5 microns)- from 0, 5 to 1, 5 mm, and in the ultraviolet region (0. 3-0. 5 microns), laser radiation is strongly absorbed by the epidermis and therefore penetrates into the tissues at a shallow depth, from 0. 2 in0. 4 mm.

Laser Radiation Generation METHOD

There arepulsed and cwlasers that produce radiation. Depending on the pumping method, continuous and impulsive generation of laser radiation can be obtained. Pulsed light is generated as wavelengths that are interrupted for a certain period of time. Other lasers generate continuous light, and a special device divides this light into short segments. As a rule, continuously generated radiation lasers, in addition to physiotherapy lasers, have the property of unwanted heat release at the site of exposure, which can lead to scar changes and damage to the tissues surrounding the site of exposure.

LASER POWER LEVEL

The radiant power of medical lasers (in particular, cosmetics) varies within wide limits, determined by the purposes of their application. For continuous pump lasers, the power can vary from 0. 01 to 100 W. Pulse lasers are characterized by pulse power and pulse duration. The power of pulsed lasers is greater for some graters. Thus, a neodymium laser generates a pulse with an energy of E = 75 J, the duration of which is t = 3x10-12 s. Pulse power: P = E / t = 2. 5x1013 W (for comparison: the power of the hydropower plant is approximately 109 W).

In cosmetological practice, including skin rejuvenation procedures, laser radiation is used for both low energy (low intensity laser radiation, LILI) and high (high intensity laser radiation, VILI).

Low Intensity Laser Radiation (LLLT)

The action of LLLT is to activate cell membrane enzymes and stabilize lipids. LILI is known to stimulate cell division and development. The effect occurs at a delicate, atomic-molecular level, where energy is absorbed under the influence of laser radiation of a certain frequency (as a rule, in the red and infrared range). Such energy absorption leads to a sharp increase in intracellular Ca2 + concentration, i. e. there is an activation of ATP accumulation and release, restoration of cell membranes, an increase in intracellular metabolism and an increase in regenerative processes due to activationof cell proliferation (division). Old cells are intensively replaced with new ones and the biorhythm of this process is restored. Therapy uses low intensity lasers (with an intensity of 0, 1–10 W / cm2). The maximum wavelength for therapeutic lasers is 1300 nm. In particular, diode lasers are used for skin rejuvenation procedures:

  • emitters with wavelengths of 890 nm and 915 nm (laser refresh);
  • low-intensity lasers with a wavelength of 785 to 890 nm (laser biorevitalization and laser mesotherapy - delivery of active ingredients to the skin through LLLT).

Therapeutic laser treatments are painless and comfortable for the patient due to their low intensity. In some cases, you may feel a slight warmth. However, there is no rehabilitation period, in order to achieve any pronounced effect (improving skin elasticity and firmness, microlerification, hydration and lifting of the skin), a course of supportive procedures and procedures is required.

The basic set of therapeutic lasers includes a device combined with a control panel (sometimes in the form of a touch screen) and a hand emitter. The kit may include several emitters (for example, with a large work surface to work on the body and with a small area to work on the face), as well as attachments for various procedures. Therapeutic lasers have small dimensions, low power consumption and the ability to install the working medium directly on the handpiece, without using a light guide tool to deliver radiation.

High Intensity Laser Radiation (Wheels)

High intensity laser radiation (2500 J / cm2) allows to concentrate considerable energy in a small volume, which causes local thermal heating, rapid evaporation and hydrodynamic explosion in a biological environment. In cosmetology, VILI has the widest application, one of which is skin rejuvenation.

Skin rejuvenation using high intensity laser radiation is a modern method of lifting, removing and / or reducing the depth of wrinkles, and improving skin quality. For high-intensity laser rejuvenation, those devices are used whose radiation is well absorbed by water (since the skin is 77 percent water). The purpose of using such lasers is a rapid rise in temperature in the region of absorption of a laser pulse with immediate tissue evaporation.

Among the variety of high-intensity laser equipment for skin rejuvenation, it is common for specialists to distinguish two main types of equipment:non-ablativeandablative methods.

Ablation - the evaporation of surface tissue by laser exposure.

Laser ablation devicesare extremely effective in combating age-related changes in the skin: the degradation of collagen and elastin - the skin's structural proteins that provide it with firmness and elasticity. Laser trauma treatments are applied to trigger rejuvenation processes. Furthermore, it should be noted that the stronger the damage, the stronger the rejuvenating effect, but at the same time, of course, the longer the rehabilitation period and the higher the risk of side effects. .

This is why the main trends in the development of modern laser for skin rejuvenation are the search for a compromise, an attempt to find a way to minimize the trauma to the skin, but at the same time get a strong response toa regenerative response.

Modern ablation devices include:

  • CO2 laser (carbon dioxide laser);
  • YAG erbium fraction laser (solid state crystal laser-atrium-aluminum-garnet with erbium ions).

The term "fractional" should be clarified immediately.

A fractional laser differs from a conventional laser in that the laser beam is strongly divided into a group of micro-rays ("fractions"). This can be applied to the device in several ways:

  1. with the help of micro-lenses installed on the wrist (a large number of rays fall on the skin at the same time);
  2. in scanner mode, when a laser beam continuously perforates the skin;
  3. with a roller attachment, which is controlled by laser pulses and allows the procedure to be performed in motion.

This leads to the fact that the laser effect on a particular area of ​​skin does not become total, but zonal: not the entire surface of the skin is exposed to the effect, but thousands of its micro-areas, among which remains the tissue ofintact. Fractional lasers are less traumatic: at the time of tissue processing, they do not cover the entire surface of the skin, but from 3 to 70 percent, depending on the laser settings, while triggering the recovery mechanism throughout the area.

In fact, thanks to the advent of fractional lasers, a new era of laser cosmetology began: laser procedures have become less painful, safer ("delicate"), the rehabilitation period as the procedures have been significantly reduced(from two days to a week). At the same time, clinical effectiveness did not decrease, but, on the contrary, increased.

Modern carbon dioxide lasersoperate on the principle offractional photothermolysis, which consists of the formation of coagulation microzones in the form of columns perpendicular to the surface. The term "photothermolysis" here means the destruction of tissue under the influence of temperature, which arose in the process of transferring laser energy to tissue (photo - light, thermal heating, lysis - destruction). The carbon dioxide laser has a radiation wavelength of 10. 6 microns. When performing the partial rejuvenation procedure, this laser removes skin microzones virtually the entire depth of the epidermis (up to 20 microns), while the area of ​​thermal damage extends to the dermis by 150 microns or more, causing collagen to coagulate. This leads to the desired effect (reduction of denatured collagen fibers, softening of the skin).

There are a number of fractional carbon dioxide devices on the market today with adjustable flux density and pulse duration. This allows you to choose the temperature and depth of heat of the dermis. Thanks to new technologies, the time for a complete post-procedural recovery is reduced to one week. Firms - distributors of modern carbon dioxide lasers began to advertise the procedures performed with their help as "weekend" rejuvenation procedures, as during fractional laser photothermolysis, the period of "acute" rehabilitation (intense edema and erythema) takes place intwo days off and on Monday the patient can go to work.

The Erbium laser has a wavelength of 2. 94 microns and a much higher absorption coefficient than a carbon dioxide laser. Erbium laser radiation penetrates to a depth of about 1 micron, causing rapid evaporation of a thin layer of epidermis, without any damage to the surrounding tissues.

“The Erbium Laser (Er: YAG) is a typical ablative laser. The effect of ablation is so pronounced that the upper layer of the epidermis evaporates immediately without leaving any trace. This laser is suitable for reappearance, softening of wounds, removal of pigmentation ".

Today, erbium lasers are actively used when working with the most sensitive areas: neck and décolleté, paraorbital and periorbital areas. With this laser, each point can be processed several times, while the doctor has the ability to control the entire "grinding" process. It is erbium lasers that are actively used surgically by plastic surgeons. Also, erbium lasers are preferred when the patient is not ready for long-term rehabilitation.

High-intensity non-ablative lasersdo not work on the principle of evaporation, but on the principle of water heating and coagulation with the formation of new collagen in the affected areas.

To apply the non-ablative method, as a rule, a laser with a large depth of penetration into the tissue is selected. In this category, for renewal, mainly usedneodymium laser (Nd: YAG) (ytrium-aluminum-garnet crystal doped with neodium), with a wavelength of 1064 nm, which corresponds to the near infrared spectrum.

Radiation from such a laser can penetrate the dermis to a depth of 5 mm. For the purpose of skin rejuvenation, this laser is commonly used in the millisecond and nanosecond range, which allows the stimulation of collagen synthesis (in almost all cases) without damaging the surrounding tissues, i. e. in a non-ablative manner. But when concentrated in a small place, it can also be used for ablation.

In modern cosmetology, the neodymium laser is mainly used to remove unwanted vessels, such as spider veins, but also to regenerate photos. The technique even has a special name -non-ablative skin remodeling. In this case, the object of influence is hemoglobin. The purpose of the action is to stimulate the growth of collagen. Heat is generated where laser radiation is most absorbed, such as the upper papillary layer, and spreads to nearby tissues. The consequence is a predictable inflammatory response that causes changes in dermal collagen synthesis with an accompanying skin rejuvenating effect. Thus, due to the partial coagulation of the microvascular bed and the partial denaturation of the collagen structure, the laser causes the formation of new fibroblasts.

I would especially like to note the latest developments in the field of laser technologies for skin rejuvenation - the advent of point-second lasers.

“In 2015, the central theme of all major international conferences on laser medicine was the use of point-second lasers for rejuvenation. This is a completely new and promising technology that only appeared in 2014 and received FDA approval. The principle of operation of point-second lasers goes beyond the theory of selective photothermolysis, as they affect tissues not through heat (thermolysis), but through the immediate oversaturation of the target with energy.

A pixel laser generates pulses measured in trillions of seconds. Such short pulses do not have time to cause thermal damage to tissues, but so much energy is concentrated in them that their target immediately disintegrates into microparticles, forming vacuoles. This principle of exposure is called photomechanical exposure. In response to the formation of vacuoles in the dermal layer, a reaction begins that triggers the synthesis of new collagen.

The world's leading experts in laser medicine, providing independent reports on fractional-second fractional technology, claim that these lasers provide a fractional laser-comparable fractional ablation effect, absolutely painless for the patient. But the most important argument in favor of this technology for a modern metropolitan resident is ultra-short rehabilitation, which lasts from three to twenty-four hours. It should also be noted that there is no need to spend time on anesthesia before the procedure, and the process itself, due to the very high pulse repetition rate, lasts no more than thirty minutes. "

Lasers for skin rejuvenation can be divided into profile laser and complex multifunctional laser systems ("combines").Every type of device has its pros and cons, fans and opponents. Many cosmetologists see more benefits in the so-called laser cutter.

“The modular platform makes it possible to gradually expand the skills of the esthetician by purchasing other attachments. Each nozzle has its own type of emitter and buying the nozzle is always cheaper than buying a separate device. It should be remembered that such modular systems allow the doctor to have all kinds of lasers for solving specific problems and not use a laser for both hair removal and rejuvenation, because the selective principle means that each wavelength willdo one thing. good, and all other indications are secondary. Therefore, modular devices with attachments are made so that the clinic does not buy 5-6 separate devices, but has a modular platform with different laser attachments, and this is always cheaper in terms of money and more rational forin terms of patient loading rather than six separate space lasers and is loaded with patients at best two or three days a week. "

Some people think that the multifunctional device is not suitable for large clinics where doctors work "in flight".

"Multifunctional machines have an important drawback: breaking such a combine means breaking all the functions at once, and a combine is not always a good choice for a situation where there are several specialists in the cabin. "on stream" in various offices. "

In any case, the choice is up to the buyer and depends on many factors: the size of the company, the profile, the number and specialization of doctors, the funding, after all.

“Debating about the advantages and disadvantages of both versions is like arguing about the advantages of a smartphone with a camera over a DSLR. If you want to take pictures, make phone calls, and browse the Internet at the same time, the choice is clear. But if you are a professional photographer, then the phone camera options will hardly be enough for you.

To make the right choice of laser refurbishment machine, experts recommend that you focus on the following very important aspects:

  1. it is necessary to require distributors the results of clinical trials of this model.
  2. You should talk to specialists from various salons and clinics working on devices of interest to find out their reactions.
  3. As a rule, serious companies offer clients the opportunity to test the equipment by salon specialists, so that employees and administration are able to evaluate the effectiveness and advantages of the equipment offered.
  4. All laser equipment must have a registration certificate from the Ministry of Health and a declaration of conformity from Gosstandart.
  5. You should pay attention to the fact that the use of manipulations in some models is limited, this means additional costs. Therefore, you should ask the supplier to provide a document confirming the guaranteed number of pulses and not be guided by the words of the manager who sells the device.
  6. Be sure to check with the distributor what consumables the device has (other than cranks), how often they will need to be purchased, how much they cost and if they are always available.
  7. Find out how maintenance will be done after the device warranty, under what conditions and in what terms.
  8. Find out who and how is training specialists to work on this device, how many specialists can be trained with the purchase, under what conditions, if the training will be repeated, if the staff of specialists in your salon changes and under what conditions.

In conclusion, we would like to remind you that the use of laser techniques for rejuvenation requires that beauty salons and clinics have a medical license and specialists who have the right to provide services using equipment of this class - doctors who havepassed a special training under "Standard program of additional professional education of doctors in laser medicine".