The technological advances opening up treatment opportunities for laser

New approaches to working with laser could boost treatment potential without the need to continually invest in new devices, discovers Georgia Seago.

It might not be necessary to invest in expensive new equipment in order to meet clients’ expectations this year. When it comes to laser and IPL, its new knowledge and techniques that have the potential to enhance results and profitability.

There’s been much talk lately around the ability for certain lasers to safely treat darker skin types of Fitzpatrick 4 and above for hair removal but in actuality the problem hasn’t been solved by any magic new technology. “You still have to be incredibly careful with darker skins,” says Debbie Thomas, laser specialist and owner of D. Thomas Clinic in London. “Yes, some lasers are safer than others but there are still a lot of treatments you definitely couldn’t do on darker skin.” However, she says more research means laser experts now better understand laser and tissue interaction and how to use lasers in a more refined, controlled way, “so there are less risks associated with it”.

Laser manufacturers have made steady advances towards enabling technicians to treat darker skins by tweaking existing technology. “We still have the core laser technology – Alexandrite and Nd:YAG – but the thing that has improved is how the energy gets into the skin. We have refined ways of doing this now,” says Thomas. For example, she works with a Fotona Nd:YAG laser when treating darker skins for hair removal and has successfully used it on very dark skin thanks to the development of Frac3 technology. “They’ve done some incredible things with the technology,” she says.

“For example, Frac3 uses a super shock short pulse width that is suitable for darker skins, so it’s still an Nd:YAG but they’re learning now how to make it work better for us by changing those pulse widths so we have a much wider range of options for treatment.”

New wave
Another answer to the problem is blended wavelength platforms, which several manufacturers unveiled last year. The technology opened the door to laser hair removal for many who would have previously been contraindicated, such as Middle Eastern and some Asian clients. The basic premise is to combine different percentages of Nd:YAG (widely recognised as the safest wavelength for darker skins) and Alexandrite (the power of which is best absorbed by hair) and deliver these into the skin simultaneously. Jonathan Exley, managing director of Lynton Lasers, who has a PhD in laser physics, believes there’s still potential for the technique to be developed further. “We’ve had the technology for about a year now but the technique of doing hair removal like this is really still in its infancy. We’re still learning exactly which mix is going to work best on the skin,” he says.

Medizen clinic in Sutton Coldfield uses a dual-technology laser, and aesthetician Zoe Myers says this makes a huge difference to the results achievable. “There’s a big Asian community here and we were getting to the point with a lot of clients who had fluffy, downy facial hair where we just couldn’t do any more with it beyond a slight reduction,” she explains. “But now we can achieve very safe and effective treatment of any sort of fluffy, black hair.”

Myers has also seen impressive results with the laser on both leg and spider veins. “We had an Nd:YAG previously but it wasn’t getting the best results. Our Lynton Duetto laser fires Alexandrite first to darken the vessel so that when the Nd:YAG fires it’s more strongly absorbed. With our previous laser it took six to eight treatments to get rid of the vein, but now after two or three sessions we’re seeing a massive improvement,” she says.

Sitting comfortably
Myers says her clients now report improved comfort when undergoing laser treatment compared to the pain associated with older lasers. “Manufacturers are getting better with comfort,” she says. For Thomas, this largely comes down to the improved control and precision of modern lasers, coupled with the emerging change in the ways technicians are using them. “Manufacturers are trying to make it much more results-driven. Whereas before people were looking for a general rejuvenation, now when we’re looking at someone’s skin we want to be able to precisely treat a certain issue,” she says.

For example, a therapist might want to do an anti-redness treatment but combine that in certain areas with treating pigmentation. “So, when the beam comes out of the laser we now have a lot more control over it and what it will actually do,” adds Thomas. She explains that new research in the field means technicians have a much clearer idea of what the laser is likely to do: “A few years ago we knew roughly what it was going to do but we also knew it was likely to do something unexpected, so we had to be really careful. Now we can be 95% sure what’s going to happen on a certain setting compared to maybe 80% in the past,” she says. Thomas says this means side-effects like bruising, swelling and burning are now far less common.

However, the recent crop of updated devices that promise to completely eliminate downtime shouldn’t be taken at face value. “I’m a little bit sceptical about down time,” admits Exley. “I don’t think there’s a magic technology that suddenly has the ability to limit down time, though it’s definitely something clients want.” Instead, he suggests therapists should focus more on explaining to clients that there is a necessary correlation between results and downtime.

“Anything that has minimal or low downtime will probably have a less pronounced effect in the tissue,” he says. “In all laser treatments you’re causing some sort of damage in the tissue and it’s difficult to do that without creating the need for downtime.” Myers agrees in the context of hair removal: “If you’re getting the sort of energy you need to into the hairs you’ll see redness and swelling around the follicles. If you can’t see this, it hasn’t done what we want it to do,” she says.

Thomas advises those new to laser to be wary of manufacturers’ promises that their lasers are free from limitations. “Certain manufacturers want people to buy their machines so they tell them ‘this machine will do everything and you’ll be able to treat anything’. People believe that and it’s really misleading.” She adds: “The knowledge has improved but you have to make sure you have access to that knowledge. Manufacturers need to be training therapists on a proper course in their equipment, using models, instead of just getting them to do a half-day course.”

Exley believes that, in actuality, machines that promote little or no downtime are really designed to be used with less aggressive parameters and could therefore require more treatments to get the desired results. “It’s perfectly acceptable to do that but the approach we’ve taken is to try and minimise downtime with aftercare rather than reducing the input of the laser and generally getting less pronounced results,” he says. This approach of combining topical skincare with laser treatments is something Exley hopes to develop further. “We’re working on the idea of combining active ingredients to enhance the results of laser in areas such as the treatment of light hairs, though it’s very early days at the moment,” he says.

Future proof
Thomas also gives an insight into where the sector is heading in terms of a change in approach when working with lasers. “It’s really uncommon now for people to have full-field ablation like a full CO2 laser, and a lot of people aren’t even doing really strong peels anymore because they cause a lot of redness and sensitivity long term,” she says. “It’s the same theory with laser. We’re starting to think now that it’s much better to do several treatments on a gentler setting rather than trying to do one treatment on a really aggressive setting. We’re changing how we think about things and saying ‘let’s step back and build up the result rather than trying to go all in’. Because our machines are now so much more precise, it allows us to do this more effectively,” she explains.

Picosecond is another area to watch in the future, says Exley. Though the core technology itself is no longer new, he believes its potential has been overlooked. “I think the treatment of pigmented conditions with pico laser will be massive. In theory, it’s ideally suited for treating pigmentation,” he says. The one thing we’re constantly asked about is melasma and if we could get the pico just right it’s probably the best opportunity we’ve had in a long time with laser technology to treat something that is so in demand.”

At the start of 2017, the potential for further developments in laser and what it can achieve is promising, so communicating this newfound knowledge to clients is key. “The perception is starting to change but I think the general public is still unaware of how lasers can be used in this gentler way,” says Thomas. “We’re still getting good results but we’re not being so aggressive and attacking the skin, we’re working with it and supporting it.”