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STORY HIGHLIGHTS
- At-home lasers
- Noninvasive fat reduction
- Laser-assisted drug delivery
- Laser-assisted wound healing
This year marks the 50th anniversary of one of the most transformative discoveries in modern science: the laser.
Though the laser is pervasive today in grocery stores, dental offices and commercial airlines, the technology was derided early on as a "solution looking for a problem."
Even Nobel laureate Charles Townes, PhD, whose research led to the creation of the laser, admits he never foresaw such widespread applications. Rather, he envisioned the laser's practical use in telecommunications and high-resolution spectroscopy. "I didn't even imagine lasers could be used for medicine," says Dr. Townes during a press briefing at the 30th Annual Scientific Conference of the American Society for Laser Medicine and Surgery (ASLMS) in April.
ASLMS is the premiere show for medical researchers to unveil the latest laser innovations and techniques. Fittingly, ASLMS honored 94-year-old Townes for his lifetime achievement in laser research. Reflecting on how far lasers have come, Dr. Townes marveled at the latest applications for laser-assisted drug delivery, optical imaging and surgery. "I'm delighted how useful the laser is," says Dr. Townes.
As for aesthetic applications, home devices, noninvasive fat removal and laser-assisted wound healing topped many attendees' lists of innovations that will elevate cosmetic medicine.
Home Devices
"The arrival of home devices is the biggest change this year," says Eric F. Bernstein, MD, MSE, director of Laser Surgery and Cosmetic Dermatology Centers in Ardmore, Pa.
Already used for hair removal, home lasers have potential for treating conditions such as acne and wrinkles. At ASLMS, James Leyden and Thomas Stephens presented positive results with Palomar's at-home nonablative fractional device. They found 90 percent of 124 subjects had diminished periorbital wrinkles six months after completing twice-daily treatments. The device won Food and Drug Administration approval in June 2009.
Though at-home lasers generated standing-room-only excitement at ASLMS, the devices have a dark side. In an investigation into the safety of three popular at-home intense pulsed light devices for hair removal, Godrey Town found at least one device was hazardous to the naked eye.
"You'll find at-home lasers useful and user-friendly if we get it right," says ASLMS President R. Rox Anderson, MD, during a press briefing. Dr. Anderson developed an at-home laser for hair removal.
Noninvasive Fat Reduction
Another technology raising eyebrows is noninvasive body contouring. Devices available in the U.S. include VelaShape II (Syneron), which is used for body circumferential reduction and tightening on the body; Thermage (Solta Medical), which focuses on tightening the body or face; and Zeltiq, a skin-cooling device used off label for localized reduction.
The market will expand further if Ultrashape and Liposonix (Medicis Technologies) gain FDA approval. UltraShape and Liposonix use ultrasound waves to break up the fat cells without harming the skin or other surrounding structures.
But skepticism persists over the efficacy of noninvasive body contouring. "It's difficult to assess how well they work," says Henry H.L. Chan, MBBS, PhD, FRCP, a dermatologist based in Hong Kong. "Circumference reduction does not necessarily equal volume of fat tissue."
So agrees Lori Brightman, MD, of the Laser & Skin Surgery Center of New York. "Noninvasive fat removal devices are effective, but the before and after photos are not true examples of precise results. They don't show valid measurement."
Several factors skew before and after photos, including the way a patient stands, the point of the respiratory cycle, the stage of her menstrual cycle, and whether he or she ate a big meal or consumed a large amount of fluids. Three-dimensional photography holds promise for quantifying the results of noninvasive body contouring, says Dr. Brightman.
She presented a study comparing the 3D photography to tape measuring, the most common method for tracking circumference reduction. Tape measuring resulted in 20 percent higher error than 3D imaging for measuring abdominal circumference. "No matter how precise you try to be, even something as simple as pulling a tape measure more taut skews the results," Dr. Brightman says. "3D photography more accurately measures contour and shape."
More than Cosmetic
Many cosmetic advances, such as retinoids, were discovered as pleasant side effects from medical treatments. The tables have turned. Lasers designed for cosmetic purposes are now being used for increasingly more medical applications.
One such application is laser-assisted drug delivery. Because ablative fractional CO2 resurfacing creates deep vertical channels in the skin, researchers are exploring its ability to improve absorption of topical medications.
Haedersdal et al. treated Yorkshire swine with single-hole CO2 laser and subsequently applied topical methyl 5-aminolevulinate (MAL), a porphyrin precurser used in photodynamic therapy to treat skin cancer. They found the laser enhanced drug delivery with significantly higher prophyrin fluorescence of hair follicles and dermis than with MAL alone. The authors concluded in their abstract presented at ASLMS that ablative fractional CO2 resurfacing is a practical tool for enhancing topical drug delivery.
Of interest to Elizabeth Hale, MD, a Mohs surgeon with the Laser & Skin Surgery Center of New York, were the sessions on laser-assisted wound healing. "At this point we're using lasers pretty regularly to treat surgical and traumatic scars," Dr. Hale says. "But, now there's talk of implementing lasers at the time of suture removal, and maybe even immediately after the surgical procedure, to stimulate would healing in an effort to achieve nearly invisible scars."
Future Directions
As laser researchers continue to push the boundaries of knowledge, physicians at ASLMS weighed in on where the laser industry is headed.
"Optical imaging areas are really coming along well," says Jill Waibel, MD, a private practice dermatologist in Miami, Fla. With optical imaging, a video camera can record and display laser beam penetration to make the procedure more targeted.
"For port wine stain, we want to see how deep the blood vessels are," Dr. Waibel says. "Lasers already are pretty precise tools, but simultaneous imaging equipment during treatments will make them even more precise."
Technologies are being continually improved to minimize complications and reduce treatment times, says Mitchel P. Goldman, MD, medical director of Goldman, Butterwick, Keel Cosmetic Laser Dermatology in San Diego. Dr. Goldman chatted on the exhibit floor about the Light Sheer Duet (Lumenis), designed for faster hair removal. Whereas laser hair removal used to take an hour, the Light Sheer Duet can cover the entire back in 15 minutes, he says, with less pain and burning because the device combines a larger spot size with lower energy output.
"The industry is trending toward less expensive technology that's more reliable with fewer breakdowns," Dr. Goldman says.
Ask Dr. Brightman about where she sees the laser industry headed, and she'll respond with a question: Who Knows? "Five years ago, we didn't know these technologies could be applied to procedures such as noninvasive body contouring," Brightman says. "That's the most exciting aspect of this industry."
Lauren Meade is associate editor of Healthy Aging.
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