Laser controversies: Separating truth from hype

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Laser controversies: Separating truth from hype
Jun 1, 2006
John Jesitus
Dermatology Times

For many controversies surrounding laser treatments, there are no black-and-white answers. What works for one physician or patient may not work for another, says an expert.

"With any problem one is treating, there are always going to be people who do not respond to whatever method one currently uses," says Eric F. Bernstein, M.D., director of Laser Surgery and Cosmetic Dermatology Centers in Philadelphia and New Jersey and clinical associate professor of dermatology at the University of Pennsylvania. For this reason, he recommends listening to experts' opinions to learn about other options.

HAIR REMOVAL

Regarding hair removal, Dr. Bernstein says there are so many lasers available for this purpose that the question is which one Û or combination Û to use in a given clinical situation.

"The reason it's controversial is that, like any other field, there's a lot of art in laser surgery. People have variable opinions," he tells Dermatology Times.

If a patient's hair is changing (shrinking in diameter) throughout the treatment, Dr. Bernstein says, "I often switch lasers, and which one I use in a given situation will depend upon the diameter and pigmentation of the hair, as well as the patient's skin type."

The frequency of treatment for hair removal depends on the area of the body one is treating, he adds.

"For example," Dr. Bernstein says, "facial sites may require more frequent treatments than the legs or back."

Perhaps equally controversial is the question of whether radiofrequency (RF) has a role in hair removal, Dr. Bernstein adds. "I still remain to be convinced. My question is, who does use it, and how? There are many ads bombarding people, and nobody really knows what's right."

BLOND, WHITE HAIR

Another question that often sparks heated discussion is whether one can remove blond or white hair with lasers or RF, according to Dr. Bernstein.

"I tell my patients I can't do that. I like to hear what other people have to say on this subject."

TATTOO REMOVAL

For tattoo removal, he says plastic surgeons currently use three main Q-switched lasers.

"The question is, how good is the state-of-the-art for tattoo removal? Can we remove multicolored tattoos effectively and easily?"

For some patients, Dr. Bernstein says, this is possible. However, he adds,"We must come a long way from where we are with tattoo removal. It takes a lot of treatments. And especially for multicolored tattoos, we all wish we could do it better, with fewer treatments."

LEG VEINS

For spider veins in the legs, Dr. Bernstein says, "Some people never use lasers, only sclerotherapy."

In fact, he says that half the patients he treats for leg veins already have been treated with sclerotherapy.

Usually, he says, "I'm removing the little matt telangiectasias that appeared as a result of the sclerotherapy."

As for larger leg veins, he says controversy swirls around how to use lasers such as the Nd:YAG.

"And what's the role of the Nd:YAG laser in removing red telangiectasias?" he asks. "I don't really use the 1,064 nm laser for this purpose." Many companies promote this laser because it treats hair and veins, Dr. Bernstein reports.

Nevertheless, he says, "It's not my first choice for most hair removal patients or for treating leg veins. I like sclerotherapy (or stripping) for the large veins and laser for the smaller ones."

Similarly, Dr. Bernstein explains, "Intense pulsed light (IPL) is very popular Û it's probably the most frequently sold light device. But I'm not a big fan. I don't use it because I believe it's easier to predict a patient's response to an individual wavelength."

This task becomes much more difficult when one uses a broad spectrum light source, he says.

"And I believe lasers are more effective for hair removal, vascular treatments and facial rejuvenation," Dr. Bernstein adds.

Furthermore, he says IPL devices produce too much nonspecific heat that doesn't contribute to clinical improvements when performing certain treatments like vein removal, because hemoglobin absorbs selectively at specific wavelengths.

"And that can contribute to side effects," Dr. Bernstein notes.

For skin tightening, Dr. Bernstein says, "People disagree as to what's the best device."

Some disagree whether one can even achieve skin tightening, he adds.

"In my opinion, there are probably a number of devices that work," Dr. Bernstein says, "and the jury is still out on what works the best."

NOT TO CREATE CONTROVERSY

Overall, he says the purpose of addressing controversial topics at gatherings should not be to create more controversy.

Rather, Dr. Bernstein says, "The purpose should be to create discussion and dialogue, so we can explore the various solutions that are available for the problems we're treating."

This way, "Hopefully each person in attendance can come up with some new or novel treatments to try that they haven't used in the past," says Dr. Bernstein, who moderated a recent American Society for Laser Medicine and Surgery workshop regarding controversies in laser surgery.

He says controversies can arise when people like himself voice strong opinions.

"But the reality is that everybody's right, and nobody's wrong. There are many ways to treat the same problem successfully," Dr. Bernstein says.

Moreover, he says he applauds the fortitude of anyone who speaks his or her mind in laser forums.

"There is no advantage Û only disadvantage Û to saying one's opinion on a given device," Dr. Bernstein says. "Whatever one's opinion is, it's going to upset somebody who has a different opinion, or a company that has a different device. So I give credit to people who have the courage to stand up and say, 'The emperor has no clothes.' "

Disclosure: Dr. Bernstein serves on the scientific advisory board for Lumenis and on the board of directors for Candela. He has also received research funding from Rhytec (Portrait PSR3).

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