PRACTICE PEARLS |
PATRICK BITTER, JR., MD, Advanced Aesthetic Dermatology 14651 South Bascom Avenue, Suite 200, Los Gatos,USA
email:
bitterjrmd@aol.com B 50 ❚
ROAD SPECTRUM PULSED light devices, such as intense pulsed light (IPL) and broadband light (BBL) have been used to successfully treat a wide variety of vascular and benign
pigmented lesions for nearly 20 years. IPL and BBL have become widely accepted as an effective treatment option, and in many cases even the treatment of choice, for conditions such as diffuse telangiectasias, rosacea, poikiloderma, and port wine hemangiomas. Benign pigmented lesions such as ephelides and lentigoes — freckling associated with photodamage and post-inflammatory hyperpigmentation — can all be treated successfully with broad spectrum light. Erythematous scars and inflammatory acne are also greatly improved with pulsed light therapy. Areas anywhere on the body are amenable to treatment with broad spectrum light. There are now numerous pulsed light
devices available on the market. While various parameters have been worked out for each type of device for the treatment of vascular and pigmented lesions, and for generalised photorejuvenation, the precise technique is generally never described in scientific publications. Technique is critical to achieving a successful outcome with any pulsed light device. To illustrate, one could follow precisely reported parameters for treating rosacea on the central face; however, two different operators using exactly the same parameters can achieve very different results in the same
Vascular and pigmented lesions
Patrick Bitter, Jr., MD, FAAD, describes his techniques for the treatment of vascular and pigmented lesions with broad spectrum light
patient by simply doing a different number of pulses and passes. Where one practitioner may treat the cheek with twelve pulses, the other may treat the same patient’s cheek with fifty pulses producing results that can be either a dramatic improvement or no result at all even though the parameters for both treatments are identical. The essential importance of technique in the use of IPL is nearly never explained in sufficient detail to allow a reader of a scientific paper to duplicate the results by simply attempting to follow the published parameters. This may be the primary explanation accounting for the different results seen in the numerous published clinical studies with IPL. This article will discuss important
considerations in treatment technique with pulsed light for vascular and pigmented lesions and general photorejuvenation. There are a number of parameters the
practitioner has to consider and choose from in treating pigmented and vascular lesions and for photorejuvenation with pulsed light devices. Generally these are the cut-off filter, the fluence, the pulse duration, and the temperature of the contact cooling. Each parameter has a particular effect on skin and target lesions. Understanding how each parameter can affect the treatment site is essential to choosing the optimal parameter for both vascular and pigmented targets for each different skin type.
Wavelength cut-off filters The effect the different wavelength cut-off filters have on skin can be thought of in the
January/February 2015 |
prime-journal.com
following way: lower number cut-off filters (e.g. 515 nm and 560 nm filters) allow a spectrum of light from 515 nm and 560 nm to approximately 1200 nm, respectively, to be emitted through the crystal and pass into the skin. This spectrum of light includes the shorter wavelengths of light that are preferentially absorbed by melanin containing targets in the epidermis and superficial dermis. Consequently, these shorter wavelengths would have a greater effect on pigmentation. For lighter skin types I through III these lower number cut-off filters would be preferred for a greater treatment effect on undesirable areas of hyperpigmentation, such as lentigoes and melasma. For darker skin types IV and V, where there is an abundance of epidermal melanin and thus more to target, the lower wavelength cut-off filter may create too much heat and result in the undesirable effect of a superficial epidermal burn. Choosing a lower number cut- off filter (515 nm and 560 nm) is best and thus more aggressive and effective in treatment of pigmented lesions in lighter skin types I through III while higher number cut-off filters (590 nm and 640 nm) are more conservative and thus safer for treating darker skin types IV and V.
Fluence The effect changing the fluence has on target lesions and skin is more easily understood intuitively than the effect of the other parameters. The higher the fluence the greater the thermal effect on the target tissue and the lower the fluence the lesser effect on the target
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