LASER EQUIPMENT FOR RENOVATION

The first laser (LASER stands for EnglishLight Amplificationby Stimulated Emissionof Radiationfor aesthetic purposes (recently designed, 55 years ago, in 1960. Since then, laser cosmetology is one of the most demanding fields in aesthetic medicine.

Laser devices are 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), of hydrated nails.

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

LASER DEVICE

The laser consists of three main components:

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

The energy sourcecan be an electric discharge, a flash lamp, an arc lamp, another laser, a chemical reaction, etc. , who activate the working medium with their energy.

Functional fluidis ​​the main determinant of the generated wavelength as well as other laser properties (monochrome, coherence, narrow focus). There are hundreds or even thousands of different working bodies on which a laser can be built. However, the following media are most commonly used: liquid (consisting of an organic solvent, for example, methanol, ethanol or ethylene glycol, in which chemical dyes are dissolved), gases (a mixture of gases, for example: carbon dioxide, argon, krypton or mixtures as in the neon sun laser. these lasers are more often pumped by electrical discharges), solids (such as crystals and glass. the solid material is usually activated by the addition of small amounts of chromium, neodymium, erbium or titanium ions)

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

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

Optical Resonator, the simplest form of which is two parallel mirrors, is located around the working body of the laser. The forced radiation of the working medium is reflected between the mirrors and back to the working medium, accumulating energy. The wave can be reflected many times before it comes out. In more complex lasers, four or more mirrors are used, which also form an optical resonator, but of a more complex design.

The quality of construction and installation of these mirrors is one of the most important requirements for the quality of a laser system.

Additional devices can also be fitted to the laser system to receive various effects, such as rotating mirrors, adjusters, filters and absorbers. Their use allows the parameters of laser radiation to be changed, for example, wavelength, pulse duration, etc.

TECHNICAL PARAMETERS OF LASER EQUIPMENT

Laser energy parameters:

1. Power, measured in Watt (W).
2. Energy, measured in joules (J).
3. Energy density (J / cm2).
4. Pulse duration, measured in millimeters, nano-, picoseconds.
5. Wavelength, measured in micrometers (μm) and nanometers (nm).

Laser radiation, which acts on a living organism, is subject to the phenomena of reflection, absorption, scattering. The degree 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 that have a well-defined absorption spectrum. The ability of a chromophore to absorb light from different wavelengths with different intensities is determined by the absorption spectrum. The unit of measurement of a chromophore's ability to absorb laser light is the absorption coefficient.

The absorption spectra of different chromophores differ radically. Therefore, it is important that the wavelength of the laser radiation coincides with the wavelength at the peak of the absorption capacity of the chromophore designed to be exposed.

Therefore, there is no universal wavelength, ie a laser, for all indications (appointments). Thus, a laser for hair removal can not rejuvenate the skin and vice versa. Of course, it often happens that several purposes are mentioned in the laser instructions, but in reality there will be only one problem in the effective solution of this equipment.

The penetration depth of the laser beam is inversely proportional to the absorption coefficient and therefore 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 penetration depth will be 3-7 mm, in the infrared region (0, 76-1, 5 microns) - from 0, 5 to 1. 5 mm, and in the area of ​​ultraviolet radiation (0, 3-0, 5 microns), the laser radiation is strongly absorbed by the epidermis and therefore penetrates the tissues at a shallow depth, from 0, 2 to 0, 4 mm.

METHOD OF GENERAL LASER RADIATION

There arepulses and cw lasersthat produce radiation. Depending on the pumping method, continuous and pulsed laser radiation production can be achieved. Pulsed light is generated as wavelengths that are interrupted for a specified period of time. Other lasers produce continuous light, and a special device splits that light into smaller pieces. As a rule, continuous radiation lasers, in addition to physiotherapy lasers, have the property of unwanted heat production at the exposure point, which can lead to scar changes and damage to the tissues surrounding the exposure point.

LASER OPERATING 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 range from 0. 01 to 100 W. Pulsed lasers are characterized by pulse power and pulse duration. The power of pulsed lasers is several orders of magnitude higher. Thus, a neodymium laser produces 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 station is about 109 W).

In the practice of cosmetology, including skin rejuvenation procedures, laser radiation is used at both low power value (low intensity laser radiation, LLLT) and high power (high intensity laser radiation, LIL).

LASER LOW INTENSITY RADIATION (LLLT)

The action of LLLT is the activation of cell membrane enzymes and the stabilization of lipids. LLLT is known to stimulate cell division and growth. The effect occurs at a subtle, atomic-molecular level, where energy is absorbed under the influence of laser radiation of a certain frequency (typically in the red and infrared regions). This absorption of energy leads to a sharp increase in the intracellular concentration of Ca2 +, that is, there is an activation of the accumulation and release of ATP, the restoration of cell membranes, the increase of intracellular metabolism and the increase of regenerative processes due to its activation. division). The old cells are intensively replaced by new ones and the biorhythm of this process is restored. The treatment uses low intensity laser (with intensity 0, 1-10 W / cm2). The maximum wavelength for therapeutic lasers is 1300 nm. Specifically, diode lasers are used for skin rejuvenation procedures:

• transmitters with a wavelength of 890 nm and 915 nm (laser rejuvenation).
• low intensity laser with a wavelength from 785 to 890 nm (laser biorejuvenation and laser mesotherapy - delivery of active ingredients to the skin via LLLT).

Laser treatments are painless and comfortable for the patient due to their low intensity. In some cases, you may feel a slight warmth. There is no recovery period, however, to achieve a strong result (improvement of skin elasticity and firmness, micro-elasticity, hydration and lifting of the skin), a course of procedures and supportive procedures are required.

The basic laser therapy kit includes a device in conjunction with a control panel (sometimes in the form of a touch screen) and a handheld transmitter. The kit may include various transmitters (for example, with a large body work surface and a small work area on the face), as well as components for various procedures. Therapeutic lasers have small dimensions, low power consumption and the ability to install the working tool directly on the handle, without the use of a light guide tool to provide radiation.

HIGH INTENSITY LASER RADIATION (ON)

High intensity laser radiation (2500 J / cm2) allows you to accumulate 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.

Rejuvenating the skin using high-intensity laser radiation is a modern method of lifting, removing and / or reducing the depth of wrinkles and improving skin quality. For high-intensity laser rejuvenation, these devices are used, the radiation of which is well absorbed by water (since the skin is 77 percent water). The purpose of using such lasers is to rapidly increase the temperature in the absorption region of a laser pulse by momentarily evaporating the tissue.

Among the variety of high-intensity laser equipment for skin rejuvenation, experts usually distinguish two main types of devices: fornon-removalandremoval method.

Removal - evaporation of superficial tissues by laser exposure.

Laser removal devicesare extremely effective in combating age-related changes in the skin: degradation of collagen and elastin - the skin's structural proteins that provide stability and elasticity. Traumatic laser treatments are applied to activate the renewal procedures. 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 recovery period and the greater the risk of side effects.

This is why the main trends in the development of modern lasers for skin rejuvenation are the search for compromise, an attempt to find a way to minimize skin trauma, but at the same time have a strong response to a regenerative response.

Modern removal devices include:

• fractional CO2 lasers (carbon dioxide lasers);
• YAG erbium fractional lasers (solid state crystalline yttrium-aluminum-garnet laser with erbium ions).

It is necessary to clarify the term "fax" immediately.

A fractional laser differs from a conventional laser in that the laser beam is violently divided into a number of microbes ("fractions"). This can be applied to material in a number of ways:

1. with the help of micro-lenses installed on the handle (a large number of beams hit the skin at the same time).
2. in scanner mode, when a laser beam penetrates the skin sequentially.
3. with roller attachment, which is controlled by laser pulses and allows the process to move.

This leads to the fact that the effect of the laser on a specific area of ​​the skin does not become total, but zonal: not the entire surface of the skin is exposed, but thousands of micro-areas, among which remains the unaffected tissue. Fractional lasers are less traumatic: at the time of tissue treatment, they do not cover the entire surface of the skin, but from 3 to 70 percent, depending on the laser settings, while activating the recovery mechanism throughout the area.

In fact, thanks to the advent of fractional lasers, a new era of laser cosmetology has begun: laser procedures have become less painful, safer ("sensitive"), the recovery period after the procedures has been significantly reduced (from two days to oneweek). At the same time, clinical efficacy did not decrease, but, on the contrary, increased.

Modern carbon dioxide lasersoperate according to 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, which occurred during the process of transferring laser energy to the tissue (light - light, heat - heating, solution - destruction). The carbon dioxide laser has a radiation wavelength of 10, 6 microns. During the fractional rejuvenation procedure, this laser practically removes the micro-zones of the skin along the entire depth of the skin (up to 20 microns), while the zone of thermal damage extends to the skin by 150 microns or more, causing the collagen to coagulate. This leads to the desired result (reduction of denatured collagen fibers, smoothing of the skin).

There are many fractional carbon dioxide devices on the market today with adjustable flow density and pulse duration. This allows you to select the temperature and depth of heating of the skin. Thanks to new technologies, the time for a complete recovery after the procedure is reduced to one week. Companies - distributors of modern carbon dioxide lasers began to advertise the procedures performed with their help as "weekend" rejuvenation procedures, as during fractional laser photothermolysis, the "acute" period takes place. in two days and on Monday the patient can go to work.

The Erbium laser has a wavelength of 2. 94 microns and a much higher absorption rate for water than a carbon dioxide laser. Erbium laser radiation penetrates to a depth of about 1 micron, causing the rapid evaporation of a thin layer of skin with virtually no damage to the surrounding tissues.

The Erbium Laser (Er: YAG) is a standard laser remover. The removal effect is so intense that the top layer of the skin evaporates immediately without leaving a trace. This laser is suitable for reintegration, smoothing scars, removing staining. "

Today, erbium lasers are actively used when working with the most sensitive areas: neck and décolleté, paraorbital and peripheral areas. With this laser, each spot can be treated several times, while the doctor has the ability to control the entire "grinding" process. They are erbium lasers that are actively used intraoperatively by plastic surgeons. Erbium lasers are also preferred when the patient is not ready for long-term recovery.

Non-abrasive high-intensity lasersdo not work at the beginning of evaporation, but at the beginning of water heating and coagulation with the formation of new collagen in the affected areas.

For the application of the non-subtraction method, as a rule, a laser with a large depth of penetration into the tissue is selected. In this category, for rejuvenation, theneodymium (Nd: YAG)laser (yttrium-aluminum-garnet crystal with neodymium) is used, which has a wavelength of 1064 nm, which corresponds to the near-infrared spectrum. .

The radiation of such a laser can penetrate the skin to a depth of 5 mm. For the purpose of skin rejuvenation, this laser is usually used in the range of milliseconds and nanoseconds, which allows the stimulation of collagen synthesis (in almost all cases) without destroying the surrounding tissues, ie in a non-abstract function. However, when you focus on a small point, it can also be used for catalysis.

In modern cosmetology, the neodymium laser is mainly used to remove unwanted blood vessels, for example, spider veins, but also for photorejuvenation. The technique even has a special name -non-abstract skin reshaping. 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 more absorbed, such as the upper papillary layer, and spreads to nearby tissues. The consequence is a predictable inflammatory response that causes changes in the composition of skin collagen with the simultaneous effect of skin renewal. Thus, due to the partial coagulation of the microvascular bed and the partial denaturation of the collagen structure, the laser activates the formation of young fibroblasts.

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

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

The picosecond laser produces 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 immediately decomposes into microparticles, forming vacuoles. This principle of exposure is called photomechanical exposure. In response to the formation of voids in the dermal layer, a reaction begins that activates the synthesis of new collagen.

The world's leading experts in laser medicine, who provide independent reports on picosecond fractional technologies, claim that these lasers provide a result comparable to traditional fractional laser removers, completely painless for the patient. But the most important argument in favor of this technology for a modern metropolitan is the extremely short recovery, which takes three to twenty-four hours. It should also be noted that you do not need to spend time on anesthesia before the procedure and the procedure itself, due to the very high pulse repetition rate, takes no more than thirty minutes. "

Lasers for skin rejuvenation can be divided into laser profiles and complex multifunctional laser systems ("combines").Each type of equipment has its advantages and disadvantages, its fans and rivals. Many cosmetologists see more benefits in the so-called laser harvester.

"The modular platform allows the aesthetic capabilities to be gradually expanded by purchasing other attachments. Each nozzle has its own type of transmitter and buying a nozzle is always cheaper than buying a separate device. We must remember that suchModular systems allow the doctor to have all types of lasers to solve specific problems and not use a laser for both hair removal and rejuvenation, because the selective principle implies that each wavelength will do a trick, and all othersTherefore, modular devices with attachments were made so that the clinic did not buy 5-6 separate devices, but had a modular platform with different laser components and this is always cheaper in terms of money and more reasonable in terms of loading. patients with six separate lasers, each of which takes up space and is loaded with patientsat 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 major drawback: interrupting such a combination would mean interrupting all operations at once, and a combination is not always a good choice for a situation where there are several experts in the" flow "cab in differentoffices. "

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 doctors, funding, in the end.

"Talking about the pros and cons of both versions is like supporting the pros of a DSLR camera smartphone. If you want to take photos, call and surf the internet at the same time, the choice is obvious. But if you are a professional photographer, then the capabilities of the phone camera will not be enough for you. "

To make the right choice of laser rejuvenation machine, experts suggest 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 should talk to experts 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 experts, so that employees and management 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 compliance with the State Standard.
5. Please note that the use of controls on some models is limited and involves additional costs. Therefore, you should ask the supplier to provide a document confirming the guaranteed number of pulses and not be guided by the words of the administrator who sells the device.
6. Be sure to check with the distributor what consumables the device has (other than handling), how often they should be purchased, how much they cost and if they are always available.
7. Learn how the device will be serviced after the warranty, under what conditions and for what period of time.
8. Find out who trains specialists to work on this device, how many specialists can be trained on the market, under what conditions, if the training will be repeated, if the specialist staff in your salon changes and under what conditions.

In conclusion, we would like to remind you that the use of laser techniques for rejuvenation requires beauty salons and clinics to have a medical license and specialists who have the right to provide services using equipment of this class - doctors who have received special trainingin the framework of the "Standard program of additional professional training of doctors in laser medicine".