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LASERS IN PLASTIC SURGERY Souvik Adhikari
A long time ago…… GOD said “Let there be light , and there was light, and GOD saw that it was good, and GOD divided the li...
DEFINITION <ul><li>Light Amplification by the Stimulated Emission of Radiation (acronym coined by Gordon Gould). </li></ul>
 
 
CONCEPTUALIZATION
HISTORY OF LASERS <ul><li>1917: Albert Einstein developed the theoretical concept of photons & stimulated emission. </li><...
PIONEERS
HISTORY OF LASER <ul><li>1960s: Dr. Leon Goldman: Father of Laser Medicine & Surgery-usage of laser in medical practice. <...
PIONEERS
BASIC PROPERTIES OF LASER <ul><li>Photons are emitted parallel & in phase with each other (coherence: intensity does not d...
 
PROPERTIES <ul><li>Frequency doubling: passing a laser beam through a KTP crystal. </li></ul><ul><li>Continuous wave & pul...
 
 
 
 
PORT WINE STAIN (PWS) <ul><li>Never regress. </li></ul><ul><li>Blood is the major chromophore. </li></ul><ul><li>OxyHb: ab...
PWS: OTHER LASERS <ul><li>IPL systems: high intensity flashlamps, used for purple, hypertrophic & resistant lesions. </li>...
COMPLICATIONS <ul><li>Reticulation. </li></ul><ul><li>Immediate skin graying/whitening. </li></ul><ul><li>Hyper & hypopigm...
PWS: EFFECTS OF LASERS
CANDELA’S DYNAMIC COOLING DEVICE
PWS WITH DCD
LASER TREATMENT OF HEMANGIOMAS <ul><li>Proliferating hemangiomas: to resolve/prevent further proliferation & to treat ulce...
PROLIFERATING HEMANGIOMAS
PROLIFERATING HEMANGIOMAS
ULCERATED HEMANGIOMAS
RESIDUAL TELANGIECTASIA
ACQUIRED VASCULAR LESIONS <ul><li>Facial telangiectasias: CW & quasi CW lasers: APTDL, copper vapor lasers. </li></ul><ul>...
FACIAL TELANGIECTASIAS
SPIDER ANGIOMATA
POIKILODERMATOSIS
PIGMENTED LESIONS <ul><li>Epidermal: ephelids, lentigines, café-au-lait macules, seborrheic keratoses, nevi spilus, Becker...
MELANIN ABSORPTION SPECTRUM
LENTIGINES
CALM OF THIGH
FRECKLES
NEVUS OF OTA
CONGENITAL NEVUS
TATTOOS <ul><li>First lasers used were CO2 & argon lasers: hypertrophic scar formation. </li></ul><ul><li>PDL, QS lasers a...
TATTOOS
INCOMPLETE CLEARING
INK DARKENING
CO2 LASERS & SKIN LESIONS <ul><li>Chromophore is water. </li></ul><ul><li>Used in actinic keratosis, condyloma acuminatum,...
RHINOPHYMA TREATED WITH CO2 LASER
SKIN RESURFACING & CO2 LASERS <ul><li>Advantages: efficient single pass removal of epidermis, heat induced collagen shrink...
FACIAL RESURFACING
SKIN RESURFACING: Er:YAG LASERS <ul><li>16 times better absorbed by water than CO2. </li></ul><ul><li>Depth of penetration...
TREATMENT OF RHYTIDES
PERIORBITAL RHYTIDES
COMBINED LASER RESURFACING <ul><li>Resurfacing with UPCO2 followed by Er:YAG. </li></ul><ul><li>Derma-K laser: near simult...
UPCO2 & Er:YAG
DERMA-K
SCARS & STRIAE <ul><li>PDL: hypertrophic scars & striae, keloids require additional treatment. </li></ul><ul><li>Atrophic ...
STRIAE DISTENSAE
ATROPHIC FACIAL SCARS
NONABLATIVE SKIN REJUVENATION <ul><li>Thermal injury to papillary & superficial reticular dermis sparing the epidermis. </...
DERMAL REMODELING
ACNE TREATMENT
LEG VEINS <ul><li>Telangiectasia, venulectasia & reticular veins excellent targets: PDL, KTP lasers, IPL. </li></ul><ul><l...
ALEXANDRITE & Nd:YAG LASERS FOR LEG VEINS
LASER HAIR REMOVAL <ul><li>Indications: hypertrichosis, hirsutism, aesthetic & medical reasons. </li></ul><ul><li>Photothe...
LASER ASSISTED HAIR TRANSPLANTATION <ul><li>Pulsed & scanned CO2 lasers can control bleeding in hundreds of recipient site...
RECIPIENT SITE CREATION
&quot;If you don't need the laser, you don't use it&quot;  Leon Goldman
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Lasers In Plastic Surgery

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Transcript of "Lasers In Plastic Surgery"

  1. 1. LASERS IN PLASTIC SURGERY Souvik Adhikari
  2. 2. A long time ago…… GOD said “Let there be light , and there was light, and GOD saw that it was good, and GOD divided the light from the darkness”
  3. 3. DEFINITION <ul><li>Light Amplification by the Stimulated Emission of Radiation (acronym coined by Gordon Gould). </li></ul>
  4. 6. CONCEPTUALIZATION
  5. 7. HISTORY OF LASERS <ul><li>1917: Albert Einstein developed the theoretical concept of photons & stimulated emission. </li></ul><ul><li>1954: Charles Townes & Arthur Schawlow built the first MASER using ammonia and microwave energy. </li></ul><ul><li>1960: Thomas Maiman produced the first laser using a synthetic ruby rod. </li></ul><ul><li>1960: Dr. Ali Javan-first continuous laser (He-Ne 632.6 nm red gas ion laser. </li></ul>
  6. 8. PIONEERS
  7. 9. HISTORY OF LASER <ul><li>1960s: Dr. Leon Goldman: Father of Laser Medicine & Surgery-usage of laser in medical practice. </li></ul><ul><li>1962: Bennett et al: blue-green argon laser (retinal surgery). </li></ul><ul><li>1964: Kumar Patel: CO2 laser. </li></ul><ul><li>1964: Nd:YAG laser. </li></ul><ul><li>1969: dye laser. </li></ul><ul><li>1975: excimer laser (noble gas-halide). </li></ul>
  8. 10. PIONEERS
  9. 11. BASIC PROPERTIES OF LASER <ul><li>Photons are emitted parallel & in phase with each other (coherence: intensity does not decrease with distance). </li></ul><ul><li>Light from laser is monochromatic but wavelength is modifiable. </li></ul><ul><li>High photon emission (even more than sun!!). </li></ul><ul><li>Only those atoms & molecules possessing a metastable stage can undergo lasing. </li></ul><ul><li>4 types of lasing materials: solid, liquid, gas, semiconductor. </li></ul>
  10. 13. PROPERTIES <ul><li>Frequency doubling: passing a laser beam through a KTP crystal. </li></ul><ul><li>Continuous wave & pulsed lasers. </li></ul><ul><li>Q switching. </li></ul><ul><li>Laser delivery: articulated arms (CO2, Er:YAG lasers), optical fibers, micromanipulators. </li></ul><ul><li>Laser-tissue interactions: reflection, scattering, transmission, absorption. </li></ul>
  11. 18. PORT WINE STAIN (PWS) <ul><li>Never regress. </li></ul><ul><li>Blood is the major chromophore. </li></ul><ul><li>OxyHb: absorption peaks at 418, 542, 577 nm. </li></ul><ul><li>Argon laser: high incidence of scarring, arophy & hypopigmentation. </li></ul><ul><li>Flashlamp pumped pulsed dye laser: selective photothermolysis, thrombosis formation without epidermal/dermal damage. </li></ul>
  12. 19. PWS: OTHER LASERS <ul><li>IPL systems: high intensity flashlamps, used for purple, hypertrophic & resistant lesions. </li></ul><ul><li>Pulsed KTP lasers: higher incidence of adverse effects like scarring, altered pigmentation. </li></ul><ul><li>Alexandrite, diode, Nd:YAG lasers are currently being explored. </li></ul>
  13. 20. COMPLICATIONS <ul><li>Reticulation. </li></ul><ul><li>Immediate skin graying/whitening. </li></ul><ul><li>Hyper & hypopigmentation (transient). </li></ul><ul><li>Atrophic & hypertrophic scars. </li></ul><ul><li>Dermatitis. </li></ul>
  14. 21. PWS: EFFECTS OF LASERS
  15. 22. CANDELA’S DYNAMIC COOLING DEVICE
  16. 23. PWS WITH DCD
  17. 24. LASER TREATMENT OF HEMANGIOMAS <ul><li>Proliferating hemangiomas: to resolve/prevent further proliferation & to treat ulceration: pulsed dye laser. </li></ul><ul><li>Ulcerated hemangiomas: treatment. </li></ul><ul><li>Compound/deep lesions: ILT using Nd:YAG or diode laser. </li></ul><ul><li>Involuting hemangiomas: treatment of residual telangiectasia: Pulsed dye, KTP, copper bromide lasers. </li></ul><ul><li>Atrophic scarring: CO2, Er:YAG laser. </li></ul>
  18. 25. PROLIFERATING HEMANGIOMAS
  19. 26. PROLIFERATING HEMANGIOMAS
  20. 27. ULCERATED HEMANGIOMAS
  21. 28. RESIDUAL TELANGIECTASIA
  22. 29. ACQUIRED VASCULAR LESIONS <ul><li>Facial telangiectasias: CW & quasi CW lasers: APTDL, copper vapor lasers. </li></ul><ul><li>Spider angiomata, cherry angiomata, poikilodermata, venous lakes, pyogenic granulomas: PDL. </li></ul>
  23. 30. FACIAL TELANGIECTASIAS
  24. 31. SPIDER ANGIOMATA
  25. 32. POIKILODERMATOSIS
  26. 33. PIGMENTED LESIONS <ul><li>Epidermal: ephelids, lentigines, café-au-lait macules, seborrheic keratoses, nevi spilus, Becker’s nevi – Q switched lasers, PDL. </li></ul><ul><li>Dermal: Nevus of Ota, melanocytic nevi, melasma, postinflammatory hyperpigmentation – QS lasers, alexandrite lasers, resurfacing with CO2 lasers. </li></ul><ul><li>Side effects: hyperpigmentation, transient hypopigmentation. </li></ul>
  27. 34. MELANIN ABSORPTION SPECTRUM
  28. 35. LENTIGINES
  29. 36. CALM OF THIGH
  30. 37. FRECKLES
  31. 38. NEVUS OF OTA
  32. 39. CONGENITAL NEVUS
  33. 40. TATTOOS <ul><li>First lasers used were CO2 & argon lasers: hypertrophic scar formation. </li></ul><ul><li>PDL, QS lasers are most commonly used now. </li></ul><ul><li>Side effects: pigment & textural changes, allergic reactions, ink darkening, tissue aerosolization with possible infectious particles. </li></ul>
  34. 41. TATTOOS
  35. 42. INCOMPLETE CLEARING
  36. 43. INK DARKENING
  37. 44. CO2 LASERS & SKIN LESIONS <ul><li>Chromophore is water. </li></ul><ul><li>Used in actinic keratosis, condyloma acuminatum, epidermal nevus, lichen sclerosis, porokeratosis, verruca plantaris, verruca vulgaris, adenoma sebaceum, cylindromas, leiomyomas, neurofibromas, syringomas, etc. </li></ul><ul><li>Effective hemostasis with sterile wound bed. </li></ul><ul><li>No tissue specimen is available for pathologist! </li></ul>
  38. 45. RHINOPHYMA TREATED WITH CO2 LASER
  39. 46. SKIN RESURFACING & CO2 LASERS <ul><li>Advantages: efficient single pass removal of epidermis, heat induced collagen shrinkage, limited ablation depth with single pass vaporization, hemostasis. </li></ul><ul><li>Complications: postoperative swelling, erythema, itching, infection, acne & milia, hyperpigmentation, hypopigmentation, petechiae, scarring, ectropion. </li></ul>
  40. 47. FACIAL RESURFACING
  41. 48. SKIN RESURFACING: Er:YAG LASERS <ul><li>16 times better absorbed by water than CO2. </li></ul><ul><li>Depth of penetration 1/20 of CO2 laser. </li></ul><ul><li>Much lesser zone of thermal injury created: lower incidence of scarring. </li></ul><ul><li>Bleeding is a major problem, less collagen contraction than CO2 laser. </li></ul><ul><li>Resurface nonfacial skin: neck, hands, forearms. </li></ul><ul><li>Mild-moderate rhytides/acne scar treatment. </li></ul>
  42. 49. TREATMENT OF RHYTIDES
  43. 50. PERIORBITAL RHYTIDES
  44. 51. COMBINED LASER RESURFACING <ul><li>Resurfacing with UPCO2 followed by Er:YAG. </li></ul><ul><li>Derma-K laser: near simultaneous beam. </li></ul><ul><li>Sandwich technique: Er:YAG followed by CO2 followed by Er:YAG. </li></ul><ul><li>CO3 laser: single head Er:YAG laser with extended pulse duration. </li></ul><ul><li>Sciton Contour Laser Resurfacing: 2 Er:YAG heads of different pulse durations. </li></ul>
  45. 52. UPCO2 & Er:YAG
  46. 53. DERMA-K
  47. 54. SCARS & STRIAE <ul><li>PDL: hypertrophic scars & striae, keloids require additional treatment. </li></ul><ul><li>Atrophic facial scars: CO2 and Er:YAG lasers. </li></ul><ul><li>Nonablative laser scar remodeling: Nd:YAG & 1450 diode lasers. </li></ul>
  48. 55. STRIAE DISTENSAE
  49. 56. ATROPHIC FACIAL SCARS
  50. 57. NONABLATIVE SKIN REJUVENATION <ul><li>Thermal injury to papillary & superficial reticular dermis sparing the epidermis. </li></ul><ul><li>PDL, KTP, IPL, Q switched Nd:YAG, diode, long pulsed Nd:YAG, Er:Glass laser, PDT all used. </li></ul><ul><li>Can also be used for acne. </li></ul>
  51. 58. DERMAL REMODELING
  52. 59. ACNE TREATMENT
  53. 60. LEG VEINS <ul><li>Telangiectasia, venulectasia & reticular veins excellent targets: PDL, KTP lasers, IPL. </li></ul><ul><li>Effective skin cooling methods required with long pulsed dye lasers. </li></ul><ul><li>EVLT: for varicose veins using PDL. </li></ul><ul><li>Complications: purpura, vesiculation & crusting, pigmentary changes, scarring, thrombus formation. </li></ul>
  54. 61. ALEXANDRITE & Nd:YAG LASERS FOR LEG VEINS
  55. 62. LASER HAIR REMOVAL <ul><li>Indications: hypertrichosis, hirsutism, aesthetic & medical reasons. </li></ul><ul><li>Photothermal destruction: ruby, alexandrite, pulsed diode, long pulsed Nd:YAG lasers, IPL. </li></ul><ul><li>Photomechanical destruction: carbon suspension Q switched Nd:YAG. </li></ul><ul><li>Photochemical destruction: PDT. </li></ul><ul><li>Side effects: pain, perifollicular erythema & edema, epidermal damage, herpes simplex outbreaks, bacterial infections, pigmentary changes, scarring, etc. </li></ul>
  56. 63. LASER ASSISTED HAIR TRANSPLANTATION <ul><li>Pulsed & scanned CO2 lasers can control bleeding in hundreds of recipient sites. </li></ul><ul><li>CO2 laser can also be used to harvest donor sites but it is much slower than a scalpel and is therefore not used. </li></ul><ul><li>Disadvantages: less yield, longer postoperative crusting & erythema, telogen precipitation. </li></ul><ul><li>Er:YAG laser now used. </li></ul>
  57. 64. RECIPIENT SITE CREATION
  58. 65. &quot;If you don't need the laser, you don't use it&quot; Leon Goldman
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