LASER EQUIPMENT FOR REJUVENATION

The first laser (LASER is an abbreviation of the EnglishLight amplification by stimulated emission of radiation: amplification of light by means of induced (stimulated) radiation)for cosmetic purposes (in ruby)designed and tested very recently, only 55 years ago, in 1960. Since then, laser cosmetology has been one of the most sought after areas in aesthetic medicine.

Laser devices have been used with great success for hair removal, rejuvenation, lifting, removal of blood vessels, age spots, scars, stretch marks, post-acne, neoplasms, tattoos, for the treatment of vitiligo, psoriasis, acne (acne), ingrownnails.

Today's review of laser equipment is highly specialized: we will introduce readers in detail to skin rejuvenation devices.

LASER DEVICE

The laser consists of three main elements:

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

The power sourcecan be an electric discharge, a flash, an arc lamp, another laser, a chemical reaction, and more. which activate the work environment with their energy.

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

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

• gas;
• liquid (on inorganic or organic dyes);
• metal vapor lasers;
• solid (crystals, glass);
• semiconductor (or diode).

Optical resonator, whose simplest form is two parallel mirrors, is located around the working body of the laser. The forced emission of the working environment is reflected between the mirrors and back into the working environment, accumulating energy. The wave can be reflected many times before it comes out. More sophisticated lasers use four or more mirrors, which also form an optical resonator, but with a more sophisticated design.

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

Additional devices for various effects, such as rotating mirrors, modulators, filters and absorbers, can also be installed in the laser system. Using them allows you to change the parameters of the laser radiation, such as wavelength, pulse duration, etc.

TECHNICAL PARAMETERS OF LASER EQUIPMENT

Laser energy parameters:

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 acting on a living organism is subject to the phenomena of reflection, absorption, scattering. The extent 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 with a well-defined absorption spectrum. The ability of a particular chromophore to absorb light with different wavelengths of 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 differ radically. It is therefore 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 one laser, for all readings (meetings). So, a hair removal laser cannot rejuvenate the skin and vice versa. Of course, it often happens that several instructions are specified in the laser instructions, but in fact there will be only one problem for the effective solution of such equipment.

The penetration depth of the laser radiation is inversely proportional to the absorption coefficient and as a consequence 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 depth of penetration 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) the laser radiation is strongly absorbed by the epidermis and therefore penetrates into the tissues at a shallow depth, from 0, 2 to 0, 4 mm.

METHOD FOR GENERATION OF LASER RADIATION

There arepulsed and cw lasersthat generate radiation. Depending on the pumping method, continuous and pulsed generation of laser radiation can be obtained. Pulsed light is generated as rays of waves 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 lasers, in addition to physiotherapy lasers, have the property of unwanted heat dissipation at the site of exposure, which can lead to changes in scarring and tissue damage around the site of exposure.

LASER POWER LEVEL

The radiation power of medical (especially cosmetic) lasers varies within wide limits determined by the purpose of their application. For continuous pumping lasers, the power can vary from 0. 01 to 100 W. Pulsed lasers are characterized by pulsed power and pulse duration. The power of pulsed lasers is several orders of magnitude higher. Thus, a neodymium laser generates a pulse with energy 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 hydroelectric power plant is approximately 109 W).

In cosmetology practice, including for skin rejuvenation procedures, both low-power laser radiation (low-intensity laser radiation, LILI) and high-intensity laser radiation (high-intensity laser radiation, VILI) are used.

LOW LIGHT INTENDED LASER RADIATION (LLLT)

The action of LLLT is to activate cell membrane enzymes and stabilize lipids. LLLT is known to stimulate cell division and development. The effect is manifested at a fine, atomic-molecular level, where energy is absorbed under the influence of laser radiation with a certain frequency (as a rule, in the red and infrared range). Such energy absorption leads to a sharp increase in the intracellular concentration of Ca2 +, ie there is an activation of the accumulation and release of ATP, recovery of cell membranes, increased intracellular metabolism and increased regenerative processes due to the activation of cell proliferation. (division). The old cells are intensively replaced with new ones and the biorhythm of this process is restored. The 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 rejuvenation);
• low intensity laser with a wavelength of 785 to 890 nm (laser biorevitalization and laser mesotherapy - delivery of active ingredients to the skin via LLLT).

Treatment with therapeutic lasers is painless and convenient for the patient due to its low intensity. In some cases, you may feel a slight warmth. There is no rehabilitation period to get any pronounced effect (improving the elasticity and firmness of the skin, microrelief, moisturizing and lifting the skin), a course of procedures and maintenance procedures is needed.

The main set of therapeutic lasers includes a device combined with a control panel (sometimes in the form of a touch screen) and a nozzle-emitter. The kit can include several emitters (for example, with a large work surface for working on the body and a small area for working on the face), as well as attachments for various procedures. Therapeutic lasers are small in size, low in power consumption and able to install the working medium directly into the handpiece without the use of a light tool to deliver radiation.

HIGH RADIATION LASER RADIATION (WHEEL)

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

Skin rejuvenation with the help of high-intensity laser radiation is a modern method for lifting, removing and / or reducing the depth of wrinkles and improving the quality of the skin. For high-intensity laser rejuvenation, those devices are used whose radiation is well absorbed by the water (since the skin is 77 percent water). The purpose of using such lasers is to rapidly raise the temperature in the area of ​​absorption of a laser pulse with instantaneous evaporation of tissues.

Among the variety of high-intensity laser skin rejuvenation equipment, experts usually distinguish two main types of devices: thenon-ablativeand theablative method.

Ablation - evaporation of surface tissues by laser exposure.

Laser ablation devicesare extremely effective in combating age-related changes in the skin: the breakdown of collagen and elastin - structural proteins of the skin that provide firmness and elasticity. Traumatic laser procedures are used to trigger renewal processes. In addition, it should be noted that the stronger the injury, 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.

That is why the main trends in the development of modern skin rejuvenation lasers are the search for a compromise, an attempt to find a way to minimize skin trauma, but at the same time to obtain a powerful recovery response.

Modern ablative devices include:

• fractional CO2 lasers (carbon dioxide lasers);
• fractional erbium YAG lasers (semiconductor yttrium-aluminum-garnet crystal lasers with erbium ions).

The term "fraction" needs to be clarified immediately.

The fractional laser differs from the conventional laser in that the laser beam is forcibly divided into a set of microbeams ("fractions"). This can be implemented in hardware in several ways:

1. with the help of microlenses installed in the handpiece (a large number of rays simultaneously hit the skin);
2. in scanner mode, when a laser beam sequentially perforates the skin;
3. with a roller attachment that is controlled by laser pulses and allows the procedure to be performed on the go.

This leads to the fact that the laser effect on a certain area of ​​the skin becomes not total, but zonal: not the entire surface of the skin is exposed, but thousands of its micro-areas, between which the unaffected tissue remains. Fractional lasers are less traumatic: during tissue treatment, they do not cover the entire skin surface, but 3 to 70 percent, depending on the laser settings, while activating the recovery mechanism in the entire area.

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

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

There are a number of carbon dioxide fractional devices on the market today with adjustable flux density and pulse duration. This allows you to choose the temperature and depth of heating of the dermis. Thanks to new technologies, the time for full recovery after the procedure is reduced to one week. Companies - distributors of modern carbon dioxide lasers begin to advertise the procedures performed with their help as rejuvenating procedures "over the weekend", because during the fractional laser photothermolysis "acute" rehabilitation period (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 the carbon dioxide laser. Erbium laser radiation penetrates to a depth of about 1 micron, causing rapid evaporation of a thin layer of the epidermis with virtually no damage to surrounding tissues.

“The Erbium laser (Er: YAG) is a typical ablative laser. The ablation effect is so pronounced that the upper layer of the epidermis immediately evaporates without leaving traces. This laser is suitable for surface restoration, smoothing of scars and 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 treated several times, as long as the doctor has the ability to control the entire process of "grinding". It is erbium lasers that are actively used intraoperatively 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.

As a rule, a laser with a large depth of tissue penetration is chosen to apply the non-ablative method. In this rejuvenation category, theneodymium (Nd: YAG) laser(yttrium-aluminum garnet crystal doped with neodymium) with a wavelength of 1064 nm is mainly used, which corresponds to the near-infrared spectrum.

The radiation of such a laser can penetrate the dermis to a depth of 5 mm. For the purpose of skin rejuvenation, this laser is usually used in pulses of milliseconds and nanoseconds, which allows to stimulate collagen synthesis (in almost all cases) without damaging the surrounding tissues, ie in non-abrasive mode. But when you focus 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 for photorejuvenation. The technique even has a separate name -non-ablative dermal remodeling. In this case, the object of influence is hemoglobin. The purpose of the action is to stimulate the growth of collagen. The heat is generated where the laser radiation is most absorbed, such as the upper papillary layer, and spreads to nearby tissues. The consequence is a predictable inflammatory response, causing changes in the dermal synthesis of collagen with a concomitant effect of skin renewal. Thus, due to the partial coagulation of the microvascular bed and the partial denaturation of the collagen structure, the laser triggers the formation of young fibroblasts.

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

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

The picosecond laser generates pulses, the duration of which is measured in trillions of seconds. Such short pulses do not have time to cause thermal damage to the tissues, but so much energy is concentrated in them that their target instantly breaks down 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 causes the synthesis of new collagen.

The world's leading experts in laser medicine, providing independent reports on fractional picosecond technology, claim that these lasers provide an effect comparable to traditional ablative fractional lasers that is completely painless for the patient. But the most important argument in favor of this technology for a modern resident of the capital is the ultra-short rehabilitation, which takes from three to twenty-four hours. It should also be noted that it is not necessary to set aside time for anesthesia before the procedure, and the process itself, due to the very high frequency of pulse recurrence, takes no more than thirty minutes. "

Skin rejuvenation lasers can be divided into profile lasers and complex multifunction laser systems ("combinations").Each type of equipment has its pros and cons, its fans and opponents. Many beauticians see more advantages in the so-called laser combine.

"The modular platform allows you to gradually expand the capabilities of cosmetics by purchasing other attachments. Each nozzle has its own type of emitter and buying a nozzle is always cheaper than buying a separate device. It should be remembered that such modular systems allow the physician to have all types of lasers to solve specific problems, rather than using a single laser for both hair removal and rejuvenation, as the selective principle assumes that each wavelengthwill do one bad thing, and all other readings are secondary. Therefore, modular devices with attachments were 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 in terms ofloading the patient with six separate lasers, each of which interacts and is loaded with patients at best two or three days a week. "

Some people think that the multifunction device is not suitable for large clinics where doctors work "on the go".

"Multifunction machines have one important drawback: failure of such a combine will mean a breakdown of all functions at once, and the combine is not always a good choice for a situation where there are several specialists in the cabin" on stream "in different offices. "

In any case, the choice depends on the buyer and depends on many factors: the size of the company, the profile, the number and specialization of the doctors, the financing, in the end.

"Debating 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, call and surf the web at the same time, the choice is obvious. But if you are a professional photographer, then the capabilities of the telephone camera will hardly be enough for you. "

To make the right choice of laser rejuvenation machine, experts recommend focusing on the following very important aspects:

1. It is necessary to request the results of clinical trials of this model from distributors.
2. You need to talk to specialists from different salons and clinics working on the equipment you are interested in to find out their feedback.
3. As a rule, serious companies provide customers with the opportunity to test the device by salon specialists, so that employees and administration can assess the effectiveness and benefits of the equipment offered.
4. All laser devices must have a certificate of registration from the Ministry of Health and a declaration of conformity from Gosstandart.
5. You should pay attention to the fact that the term of use of collectors in some models is limited, this implies additional costs. Therefore, you should ask the provider to provide a document confirming the guaranteed number of pulses, and not be guided by the words of the manager selling the device.
6. Remember to check with the distributor what consumables the device has (in addition to collectors), how often they will have to be bought, how much they cost and whether they are always in stock.
7. Find out how the post-warranty support of the device will take place, under what conditions and in what period of time.
8. Find out who and how trains specialists to work on this device, how many specialists can be trained at the time of purchase, under what conditions, whether the training will be repeated if the staff of the specialists in your salon changes and under what conditions.

In conclusion, we would like to remind you that the use of laser rejuvenation techniques requires beauty salons and clinics to have a medical license and specialists who are entitled to provide services using equipment of this class - doctors who have undergone special training in "The standard program for additional professional training of surgeons' doctors ".