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In aesthetic medicine, lasers are a standard therapeutic tool for pigmentary and vascular skin disorders.

The machines currently in use include:

• Nd: YAG lasers,
• IPL devices, and
• Pulsed Dye Laser (PDL).

Currently, PDL devices have the best results in terms of efficacy and safety.

Physicians in primary care with adequate training, can administer laser therapy for pigmentary and vascular issues. The training includes skin lesions, laser devices, laser-tissue interaction, cooling systems, post-procedure care, etc. The treatment takes place in the physician’s procedure room, with all the laser use-related precaution measures.

Overview

Vascular and pigment conditions are common in the general population. The ability of lasers to target these changes without damaging the surrounding tissues makes these devices a number one choice in aesthetic medicine.

Lasers deliver the light at predetermined wavelengths maximising the absorption inside the target structure. That gives the laser the ability to aim precisely at various vascular and pigmentary changes, such as birthmarks, and successfully remove them.

With proper aftercare, skin irregularities will usually disappear after two to twelve treatment sessions. Side effects and complications are rare.

Pre-procedure counselling

Discuss the patient’s medical history, other treatment options, the potential need for multiple sessions, cost, and possible complications before the procedure. Get a signed informed consent, and make before and after digital photographs of vascular or pigmentary changes.

Contraindications

Photo-aggravated conditions and existing infections are the absolute contraindications for laser skin procedures. Treating patients with unrealistic expectations, unstable vitiligo, psoriasis, or keloid tendencies can cause inconsistent outcomes.

Procedure guidelines

Laser technology is generally effective and safe to use. However, all laser skin treatments fall into a group of aggressive procedures. Improper handling can result in damage to the skin, eyes, and other organs and tissues.

Patients in aesthetic medicine usually require treatment without medical indications. That means they have a low tolerance for side effects. Therefore, guidelines for practitioners in primary care are necessary to ensure satisfactory procedure outcomes and avoid complications.

The care providers need to know about:

• The type of laser device they are using
• Treatment indications and contraindications
• The characteristics of skin changes (location, size, color, depth, skin type, etc.)
• Aftercare measures

The main characteristics of vascular and pigmentary conditions play a valuable part in the success of the treatment. They also guide the practitioners in setting up laser parameters.

For example:

• Younger skin heals faster and reacts better to treatment
• Changes located deep in the skin require longer laser light wavelengths
• Changes in the upper torso and face respond to laser treatment better than those in the lower parts of the body
• Lighter skin is less prone to laser damage

Anaesthesia

Laser treatments usually cause tolerable discomfort. For adult patients, local anaesthesia may be necessary on request. However, most adults do not need any sedation. Young children, especially those with extensive skin changes, may require topical, local, or total anaesthesia.

 Potential side effects and complications

Side effects and complications of laser treatment for vascular and pigment conditions are rare. However, there is always a risk of redness, swelling, blistering, burns, scarring, infections, and ocular injury. That risk is shared between all types of laser skin treatment and depends on the proper application of laser devices.

Learn more with the Certificate Courses in Aesthetic Medicine

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References

• Srinivas CR, Kumaresan M. Lasers for vascular lesions: standard guidelines of care. Indian J Dermatol Venereol Leprol. 2011 May-Jun;77(3):349-68. DOI: 10.4103/0378-6323.79728. PMID: 21508585.
• Shah SD, Aurangabadkar SJ. Laser Toning in Melasma. J Cutan Aesthet Surg. 2019 Apr-Jun;12(2):76-84. DOI: 10.4103/JCAS.JCAS_179_18. PMID: 31413475; PMCID: PMC6676813.