Laser equipment for rejuvenation

The first laser (LASER is an English acronymStimulated Emission Radiation: amplification of light using induced (stimulated) radiation)for cosmetic purposes in the near future (in the form of a ruby)and tested. , only 55 years ago, in the 1960s. Since then, laser cosmetology has been one of the most sought after areas in aesthetic medicine.

Laser devices are used with great success to treat epilation, rejuvenation, lifting, removal of blood vessels, age spots, scars, stretch marks, post-acne, neoplasms, tattoos, vitiligo, psoriasis, acne (acne), sunken nails.

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

LASER DEVICE

The laser consists of three main elements:

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

Energy SourceEnergy-activating electrical discharge, flash lamp, arc lamp, another laser, chemical reaction, etc.

Working fluidis ​​the main determinant of the generated wavelength and other laser properties (monochrome, consistency, narrow focus). There are hundreds, even thousands, of different working bodies that can be laser mounted. However, the following processing agents are most commonly used: liquids (consisting of an organic solvent, such as methanol, ethanol, or ethylene glycol, where chemical dyes are dissolved), gases (a mixture of gases, such as carbon dioxide, argon, krypton, or helium). - mixtures such as neon lasers; these lasers are most often struck by electric discharge), solids (such as crystals and glass; solid material is generally activated by the addition of small amounts of chromium, neodymium, erbium or titanium ions); semiconductors.

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

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

The simplest form is the

Optical Resonator, which has two parallel mirrors around the working part of the laser. Forced radiation from the working environment is reflected between the mirrors and back into the working environment by accumulating energy. It can be reflected many times before the wave appears. More complex lasers use four or more mirrors that form an optical resonator, but with a more complex design.

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

In addition, additional devices can be installed in the laser system to achieve various effects, such as rotating mirrors, modulators, filters and absorbers. Their use allows you to change the parameters of laser radiation, for example, wavelength, pulse duration, etc.

TECHNICAL PARAMETERS OF LASER EQUIPMENT

Laser power parameters:

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

A laser beam that affects a living organism is subject to reflection, absorption, and 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, a biological structure with a specific absorption spectrum. The ability of a chromophore to absorb light of different wavelengths at 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. For this reason, it is important that the wavelength of the laser radiation coincides with the wavelength at the peak of the absorption capacity of the planned chromophore.

Therefore, there is no universal wavelength, ie a laser, for all indicators (appointments). Thus, a laser for epilation cannot rejuvenate the skin and vice versa. Of course, it often happens that the laser instructions have several goals, but in fact such equipment will be the only problem to solve effectively.

The penetration depth of laser radiation is inversely proportional to the absorption coefficient and, consequently, depends on the wavelength. The depth of penetration for different skin chromophores (water, melanin, hemoglobin, oxyhemoglobin) is also different. For example, the penetration depth in the visible region (0. 38-0. 74 microns or 380-740 nm) will be 3-7 mm, in the infrared region (0, 76-1, 5 microns) it will be between 0, 5 and 1. , 5 mm and in the ultraviolet region (0. 3-0. 5 microns) laser radiation is strongly absorbed by the epidermis and therefore penetrates into the tissues to a shallow depth of 0, 2 to 0, 4 mm.

METHOD OF LASER RADIATION GENERATION

There is radiation generated by

pulsed and cw lasers. Depending on the pumping method, continuous and pulsed laser radiation can be obtained. Pulsed light appears as waves that are cut off over a period of time. Other lasers produce continuous light, and a special device divides this light into short segments. As a rule, continuously generated radiation lasers, in addition to physiotherapy lasers, have the property of unwanted heat release at the site of exposure, which can lead to wound changes and damage to the tissues surrounding the site of exposure.

LASER POWER LEVEL

The radiation power of medical (especially cosmetic) lasers varies widely for application purposes. For continuously pumped lasers, the power can vary between 0, 01 and 100 W. Pulsed lasers are characterized by pulse power and pulse duration. The power of pulsed lasers is higher than a few orders of magnitude. Thus, a neodymium laser generates a pulse of energy E = 75 J with duration t = 3x10-12 s. Pulse power: P = E / t = 2. 5x1013 W (for comparison: the power of a hydropower plant is about 109 W).

In cosmetology practice, including skin rejuvenation procedures, laser radiation is used with both low power cost (low intensity laser radiation, LLLT) and high power (high intensity laser radiation, LILI).

LOW POWER LASER RADIATION (LLLT)

The action of LLLT is to activate enzymes of cell membranes and stabilize lipids. LLLT is known to stimulate cell division and growth. The effect occurs at a subtle, atomic-molecular level (usually in the red and infrared ranges) where energy is absorbed under the influence of laser radiation of a certain frequency. Such energy absorption leads to a sharp increase in intracellular concentrations of Ca2 +, ie an increase in regenerative processes due to the accumulation and release of ATP, regeneration of cell membranes, increased intracellular metabolism and activation of cell proliferation (division). Old cells are intensively replaced by new ones, and the biorhythm of this process is restored. 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 890 nm and 915 nm (laser rejuvenation);
• Low-intensity laser with a wavelength between 785 and 890 nm (laser biorevitalization and laser mesotherapy - delivery of active substances to the skin by LLLT).

Therapeutic laser treatment is painless and comfortable for the patient due to its low intensity. In some cases, a slight feeling of warmth is possible. There is no rehabilitation period, however, some procedure and supportive procedures are required to achieve any clear effect (improving skin elasticity and firmness, microrelief, moisturizing and lifting the skin).

The basic set of therapeutic lasers includes a control panel (sometimes in the form of a touch screen) and a device combined with a hand-piece emitter. The set can include several emitters (for example, with a large area to work on the body and a small area to work on the face) and supplements for various procedures. Therapeutic lasers are small in size, low in energy consumption, and capable of mounting the working medium directly on a piece of hand without the use of a light guide for radiation.

HIGH POWER LASER RADIATION (SOLUTION)

High-intensity laser radiation (2500 J / cm2) allows the accumulation of a significant amount of significant energy, which leads to local heat, rapid evaporation and hydrodynamic explosion in the biological environment. VILI is widely used in cosmetology, one of which is skin rejuvenation.

Skin rejuvenation using high-intensity laser radiation is a modern method to remove, remove and / or reduce wrinkles and improve skin quality. High-intensity laser rejuvenation uses devices that absorb radiation well into the water (because the skin is 77 percent water). The purpose of using such lasers is to rapidly increase the temperature in the area of ​​absorption of the laser pulse by the sudden evaporation of tissues.

Among the various high-intensity laser devices for skin rejuvenation, experts usually distinguish two main types of devices:non-ablativeandablat method.

Ablation - evaporation of surface tissues by laser exposure.

Laser ablative devicesExtremely effective in combating age-related changes in the skin: degradation of collagen and elastin - structural proteins that ensure the firmness and elasticity of the skin. Traumatic laser treatments are used to trigger regeneration processes. In addition, it should be noted that the stronger the injury, the stronger the rejuvenating effect, and, of course, the longer the rehabilitation period and the higher the risk of side effects.

Therefore, the main trend in the development of modern lasers for skin rejuvenation is the search for a compromise, an attempt to find a way to minimize trauma to the skin, while also responding strongly to the restorative response.

Modern ablative devices include:

• fractional CO2 lasers (carbon dioxide lasers);
• fraction erbium YAG lasers (itrium-aluminum-garnet crystal laser solidified with erbium ions).

The term "fraction" should be clarified immediately.

A fractional laser differs from a conventional laser in that the laser beam is forcibly divided into a large number of micro beams ("fractions"). This can be applied to the device in several ways:

1. with the help of microlenses mounted on the hand piece (at the same time a large number of rays fall on the skin);
2. In scanning mode, when a laser beam pierces the skin sequentially;
3. with a roller attachment controlled by laser pulses and allowing the procedure to move.

This causes the laser effect in a specific area of ​​the skin to become a zone, not a total: not the entire surface of the skin, but thousands of micro-areas where unaffected tissue remains. Fractional lasers are less traumatic: they do not cover the entire surface of the skin during tissue processing, but between 3 and 70 percent, depending on the laser parameters, and at the same time activate the recovery mechanism in the whole region.

In fact, with the advent of fractional lasers, a new era of laser cosmetology began: laser procedures became less painful, safer ("gentle"), and the rehabilitation period after the procedures was significantly reduced (from two days to a week). At the same time, clinical efficacy did not decrease, but increased.

Modern carbon dioxide lasersoperate on the principle offractional photothermolysis, which consists of the formation of coagulation micro-zones 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 during the transfer of laser energy to the tissue (photo - light, thermal - heating, lysis - destruction). The radiation wavelength of a carbon dioxide laser is 10. 6 microns. When performing a fractional rejuvenation procedure, this laser removes micro-zones of the skin virtually the entire depth of the epidermis (up to 20 microns), while the heat-damaged zone extends to the dermis by 150 microns or more, causing collagen to clot. This leads to the desired effect (reduction of denatured collagen fibers, smoothing of the skin).

There are a number of fractional carbon dioxide devices on the market today with regulated flow density and pulse duration. This allows you to choose the temperature of the dermis and the depth of warming. Thanks to new technologies, the full recovery period after the procedure has been reduced to one week. Distributors of modern carbon dioxide lasers began to advertise the procedures performed with their help as "weekend" rejuvenation procedures, because the "acute" rehabilitation period (intense edema and erythema) during fractional laser photothermolysis rests for two days and the patient can go on Monday.

Erbium laser has a wavelength of 2. 94 microns and a higher water absorption coefficient than a carbon dioxide laser. Erbium laser radiation penetrates to a depth of about 1 micron and causes rapid evaporation of a thin layer of epidermis without virtually any damage to the surrounding tissues.

“Erbium laser (Er: YAG) is a typical ablative laser. The ablation effect is so pronounced that the top layer of the epidermis evaporates immediately without leaving any trace. This laser is very suitable for smoothing the surface, smoothing traces, removing 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 processed several times, and the doctor has the ability to control the entire "grinding" process. Erbium lasers are actively used intraoperatively by plastic surgeons. Erbium lasers are also preferred if the patient is not ready for long-term rehabilitation.

Non-ablative high-intensity lasersdo not work on the principle of evaporation, but on the principle of coagulation by heating water and the formation of new collagen in the affected areas.

To apply the non-ablat method, as a rule, a laser with a depth of penetration into the tissue is selected. For rejuvenation in this category is usedneodymium (Nd: YAG) laser(itrium-aluminum-garnet crystal with neodymium) with a wavelength of 1064 nm, which corresponds mainly to the infrared spectrum.

Such a laser radiation can penetrate the dermis to a depth of 5 mm. In order to rejuvenate the skin, this laser is generally used in pulses of milliseconds and nanoseconds, which allows to stimulate collagen synthesis (in almost all cases) without damaging the surrounding tissues, ie in a non-ablative mode. However, while paying attention to a small area, it can also be used for ablation.

In modern cosmetology, neodymium lasers are used primarily to remove unwanted veins, such as spider veins, but also for photorejuvenation. The technique has a different name -non-ablative dermal reconstruction. In this case, the object of action is hemoglobin. The purpose of the campaign is to stimulate collagen growth. Where laser radiation is most absorbed, such as in the upper papillary layer, heat is generated and spreads to nearby tissues. The result is a predictable inflammatory response that causes changes in dermal collagen synthesis with a parallel effect of skin renewal. Thus, the laser triggers the formation of young fibroblasts due to partial coagulation of the microvascular bed and partial denaturation of the collagen structure.

I would like to note the latest developments in the field of laser technology, especially for skin rejuvenation - the emergence of lasers in picoseconds.

“In 2015, the main topic of all 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, because they do not affect the tissue by heating (thermolysis), but by the sudden saturation of the target with energy.

A picosecond laser generates pulses whose duration is measured in one trillionth of a second. Such short pulses do not have time to cause thermal damage to the tissues, but they store so much energy that their targets are immediately broken down into microparticles to form vacuoles. This principle of exposure is called photomechanical exposure. In response to the formation of vacuoles in the dermal layer, a reaction begins that triggers the synthesis of new collagen.

Leading experts in laser medicine around the world have published independent reports on fractional picosecond technology, claiming that these lasers provide patients with a completely painless, comparable effect to traditional ablative fraction lasers. But for a modern metropolitan resident, the most important argument in favor of this technology is the ultra-short rehabilitation, which lasts between three and twenty-four hours. It should also be noted that there is no need to spend time for anesthesia before the procedure, and due to the very high pulse rate, the process itself does not take more than thirty minutes. "

Lasers for skin rejuvenation can be divided into profile lasers and complex multifunctional laser systems ("combines").Each type of equipment has its pros and cons, fans and competitors. Many cosmetologists see more benefits in a product called laser hair removal.

“The modular platform allows you to buy other supplements and gradually expand the capabilities of the cosmetologist. Each nozzle has its own type of diffuser, and buying a nozzle is always cheaper than buying a separate device. It should be remembered that such modular systems allow the doctor to have all kinds of lasers to solve specific problems and do not use a laser for both epilation and rejuvenation, because the principle of selection assumes that each wavelength will do something. good and all other indicators are secondary. Therefore, the additional modular devices are designed to have a modular platform with different laser applications so that the clinic does not have to buy 5-6 separate devices, which is always cheaper in terms of money and more rational than six separate lasers in terms of patient loading. takes place and is loaded with patients at best two to three days a week. "

Some people think that a multifunction device is not suitable for large clinics where doctors work "immediately".

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

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, as a result.

“Arguing about the advantages and disadvantages of both versions is like arguing about the advantages of a smartphone with a camera over the DSLR. If you want to take a photo, make a call and browse the Internet at the same time, the choice is obvious. But if you are a professional photographer, the capabilities of a phone camera are unlikely to reach you. "

To choose the right laser rejuvenation device, experts recommend to pay attention to the following very important points:

1. The results of clinical trials of this model should be requested from distributors.
2. You should talk to the specialists of various salons and clinics working on interesting equipment and get their opinions.
3. As a rule, serious companies allow customers to have the device tested by salon professionals so that employees and management can evaluate the effectiveness and benefits of the equipment offered.
4. All laser devices must have a registration certificate from the Ministry of Health and a Gosstandart declaration of conformity.
5. On some models, you should be aware that the manipulation has a limited service life, which involves additional costs. Therefore, you should ask the supplier to provide a document confirming the guaranteed number of pulses, and you should not follow the words of the manager who sold the device.
6. Check with the distributor what consumables the device has (in addition to manipulations), how much to buy, how much to spend, and whether it is always in stock.
7. Learn how, under what conditions and under what conditions the device will be used after warranty.
8. Find out who trained the professionals to work on this device and how, how many specialists can be trained at the time of purchase, under what conditions, if the staff of specialists in your salon changes, the training will be repeated and under what conditions.

Finally, we remind you that the use of laser technology for rejuvenation requires specialists who have a medical license in beauty salons and clinics and have the right to provide services using this class of equipment - specially trained doctors under the "Standard Vocational Training Program for Physicians". laser medicine. "