What are High Energy Devices?

High energy devices refer to machines (e.g. lasers, IPL) that use energy in the form of light, heat, cold, sound or radiowave to penetrate layers of the skin to promote tissue and cell repair.

They are used traditionally for dealing with skin problems, both in a therapeutic context, and in the context of improving one’s appearance, although these aspects are by no means self exclusive. All laser treatments use energy.

High energy devices are extremely effective but should only be used in specialist environments due to the risk of adverse effects.

Laser Heritage and Research at the Cadogan Clinic

Our founder, Mr Bryan Mayou, set up one of the NHS’s first skin laser units NHS at St Thomas’ Hospital in 1985 and one of the earliest cosmetic laser units in the UK. He was the first person to do a number of laser treatments in the UK including:

  • Treatment of Birthmarks (Congenital Melanocytic Naevi) by Dermabrasion, Shaving and Carbon (1984)
  • Combination treatment of Birthmarks (Congenital Melanocytic Naevi) with surgical excision and carbon Dioxide laser (1987)
  • Pulsed Dye Laser Treatment of Port Wine Stains and other Vascular Lesions (1990)
  • Ruby Laser Treatment of Pigmented lesions of the skin (1995)

Section 1 - Lasers

‘Lasers’ are a type of high energy device with a long history of safety in medicine. Lasers use light energy to deliver their effect“

How do lasers work?

Lasers have three main components: 

  • An energy source
  • A lasing medium
  • A set of mirrors 

When enough energy excites the lasing medium, electrons jump into higher orbits around the nucleus, and in returning to their original orbits, photons are released. Photons bounce off mirrors to amplify the effect. Hence the acronym “Laser” (Light Amplification by Stimulated Emission of Radiation). 

There are various ways in which this energy is then delivered to the target

  • Fibreoptic cables
  • A periscopic lens system
  • Single bare fibers 

Lasers deliver energy in various forms to skin and the surrounding tissues (fat, blood vessels and ligaments). A vast number of lasers are now available which the experienced specialist can use to build up tissue or take it tissue away.  

Laser plays an important part in skin regeneration by stimulating the bodies own healing processes. Broadly, these effects include, changing the structure of the tissues (e.g. tightening or relaxing skin), regenerating tissues (acne scars), helping skin to mature (wound heading and scars) or targeting specific structures (e.g. healing spider veins). 

A key advantage of lasers over other high-energy devices is that they can be extremely selective on the tissues that they targets. Wavelength determines colour. One element of this selectivity is that lasers can target tissue targets with specific colour. There are three principal targets in the human body 

  • Blood (red/purple) 
  • Melanin (various shades of brown)
  • Water/collagen 

This targeting is not absolute and therefore an important skill of an experienced specialist is to improve on this accuracy. For example, whilst removing purple spider veins on a background of pale skin is relatively straightforward, achieving the same result on darker skin is much more challenging.

As the intended target absorbs this energy imparted by the laser its chemical structure starts to change. It may also fragment or explode. The result ranges from a mild stimulation of the inflammatory response to stimulation of the healing response to a purely physical effect such as drying up or destroying a blood vessel. Some lasers instantly vaporise the water in tissue and therefore the tissue itself.  Lasers can also be used to enhance the bodies response to injury and hasten wound healing, to improve wound that are not healing properly and even to regenerate body tissues. For example, carbon dioxide laser creates a controlled limited injury to the dermis. The body reacts to this by depositing new collagen which is the main component of skin. Not only does this mean that laser can be used to recreate normal body structures but the advantage gained is permanent since the collagen is the body’s own.

Cooling systems are an adjunct to lasers which helps keep patients comfortable and safe, by draining away extra heat and cooling surrounding skin.

How lasers differ from other forms of energy 

There are three distinguishing features of laser light compared to other forms of energy devices. 

Single wavelength: single wavelength light is monochromatic (one single color)

Parallel light: as light rays run parallel to each other it can be used to precisely target areas

Linear light: as the laser travels it doesn’t lose energy which allows it to deliver a high  amount of energy with each discharge.  

Traditionally, the main disadvantage of lasers is that their action is limited by skin depth. Next generation lasers use single bare fibres as thin as 150nm (a hair’s breadth)

Lasers can be classified into types which relate to the effect they cause ranging from rejivation of ageing skin to destruction of skin lesions. The classification includes:

  • Wavelength
  • Ablative and non-ablative 
  • Hot and cold 
  • Fractional and non-fractional

Wavelength

Lasers can be distinguished by their wavelength. The wavelength determines the visible skin pigment that the laser will target. The primary wavelengths of medical lasers are violet, ultraviolet and infrared, however not all colours are visible with the naked eye. Lasers target opposite coleus on the wavelength e.g. green laser targets red lesions.

Examples of lasers and their wavelengths in nanometers (one thousand-millionth of a metre) include:

Laser WavelengthTypical uses
CO210600 nmRhytides, photodamage
Er:Glass 1540 nmRejuvenation, scaring
Nd:Yag1064 /1320 nmPhotodamage
Diodee.g. 1450 nmFacial rejuvenation
KTP532 nmArterial blood
Alexandrite755 nmEpilation
Ruby694 nmTattoos
Pulse-dye590 nmArterial blood
Tunable-dyeVariableMultiple indications

Ablative and Non-Ablative Lasers

Lasers can also be distinguished by whether they ablate tissue or not. Ablation is another word for destruction, which means the outer layers of skin are destroyed and removed. All wavelengths above 2000nm are classified as ablative, all wavelengths below 2000nm are classified as non-ablative. Ablative lasers are used to wholesales remove unwanted lesions (eg seborrheic keratitis, skin tags, viral warts) whilst non-ablative lasers do not destroy their targets but instead modify them either by modifying the chemical structure or by delivering a controlled head stimulus, resulting in different effects (e.g. tightening, liposculpture)

Ablative Laser

An ablative laser removes tissue, paring it down, whilst leaving enough surrounding tissue or the skin to grow back from. Compared to surgical removal, this reduces the mismatch to the surrounding area.

Using a beam diffractor, it is possible to separate one beam to tiny pixels, which leave intact skin, either taking away surface skin, or with much finer beams, going deeper under the skin.

Ablative lasers are more invasive that non-ablative lasers, therefore it may take more time to recover from an ablative laser treatment. Depending on the area treated there may be some crusting of the skin, swelling and discomfort

These most common ablative lasers are:

  • Er: YAG (called “erbium YAG”)
  • CO2

Both lasers target water molecules. There are however some important technical differences. The affinity of Erbium YAG to water is 10x that of carbon dioxide. Therefore whilst erbium YAG can deliver more heat, carbon dioxide clots blood much more effectively. As an example erbium YAG may be used to treat very find wrinkles. A typical examples of carbon dioxide lasers or other lesions with negligible blood loss. Carbon dioxide lasers are far more powerful and therefore energy is delivered to tissues via a system of mirrors rather than fibreoptic cables. Therefore carbon dioxide laser are much more fragile and powerful and should only be used by experienced medical specialists.

Non-Ablative Lasers

A non-ablative laser keep the tissue intact, instead change its structure to create an impact. Non-ablative lasers work by heating up the underlying skin layers, without any harm to the surface layers, encouraging the production of new collagen. Non-ablative lasers can change both tissue hydration and the chemical ways in which molecules react with each other.

Non-ablative lasers are usually chosen to refine the skin’s tone and texture. Multiple treatments are needed to see considerable results with this type of laser procedure. The recovery time is far less compared to an ablative treatment.

These light treatments are considered non-ablative:

  • Visible Light Lasers
  • Near Infrared Lasers
  • IPL [not a laser)

Cold and Hot Lasers

All lasers produce different amounts of energy, with high energy lasers classified as hot lasers, and low energy lasers classified as cold lasers.

Cold Lasers

Cold lasers are called ‘cold’ because they work at low energy. They induce chemical changes in tissues to promote cellular growth and regeneration. Cold lasers work by delivering photons to individual cells to increase cellular energy. The photons are then converted into the cell’s main fuel source, Adenosine Triphosphate (ATP), by the cell mitochondria in cells.

Cold laser deliver a very mild photochemical effect at low intensity light energy that stimulate healing processes.

Cold lasers are commonly used by physiotherapists or post operatively sometimes to alter the reactions which the body produces after surgery.

Hot Lasers

Hot lasers are called ‘hot’ because they work at high energy. The vast majority of lasers in clinical use can be classified.

Hot lasers are commonly used in surgeries to replace standard tools such as scalpels, because they’re precise and do less damage to tissue. They tend to cause less swelling and bleeding, which also attributes to less recovery time for the patient.

Fractional and Non-Fractional Lasers

Lasers have witnessed tremendous advances since their discovery in the 1960s culminating in the Nobel Prize 2018 awarded to the inventors of laser. One major development in rejuvenation is the ability to split a laser beam into tiny beams which are placed a small distance away from each other. As the beam is split, this type of laser is called a fractioned laser. This fractioned modality can be applied to various lasers (e.g ablative or not-ablative) and when this fractioned modality is not applied the laser is considered non-fractional.

Fractional Laser

Fractioned laser has distinct advantages compared to its predecessors. As it does not affect the entire surface area much faster healing is possible as tissue heals from the sides as well as from the base. Because these split beams are infinitesimally small they are nearly invisible, creating microscopic holes that cause much less oozing and bleeding but still retain a remarkable ability to cause dermal regeneration (see above). We can think of this as a pattern of pixels on a blank canvas. One particular use is in facelift and skin resurfacing. Twenty years ago, an ablative laser would have resulted in 100% of the skin surface being ablated. Downtime would have been two weeks upwards and involved oozing, bleeding and significant discomfort as well as the risk of scaring. Using the same ablative modality but on a fractioned setting now enables much shorter downtimes (in the order of 5-7 days), improved safety and reduced discomfort. Much more recently the same microscopic holes have bene also used to deliver medications right through the skin. This new branch of pharmacosurgery is called laser assisted drug delivery (LADD). This can be used to deliver mesotherapy, helps scars mature or hasten wound healing.

Typical uses of fractional lasers include

  • Improving facial texture
  • Removing superficial age spots
  • Improving skin laxity (droopy or sagging skin)

Non-fractioned laser

Non-fractioned lasers use a full beam to target tissue. Used appropriately, a full beam reaches deeper into tissues and can be used to destruct unwanted lesions (for example, viral warts) or even target anatomical structures such as nerve, small arteries, veins and even skin cancer.

  • Typical uses of non-fractional lasers include
  • Removing deeper wrinkles
  • Scarring, such as acne scars
  • Treating deep age spots
  • Treating very droopy or sagging skin issues

Millisecond, nanosecond and picosecond lasers

The effect of a laser also depends on the duration or the time during which energy is released. The longer the pulse the more likely this will result in heating, the shorter the pulse the more likely the effective is brought about by a purely mechanical effect. This results in different uses and different applications

A millisecond laser delivers energy over a longer timespan this results in the target heating up faster than it can lose heat. As a result the target molecule is destroyed or chemically altered. For example, this is the way that spider veins are treated.

A Nanosecond laser are also called Q-switch lasers. This stands for Quality switch. The same energy is released in a timespan one thousand times shorter than a millisecond laser. The same energy is released in a timespan that is much shorter than a millisecond lasers. As a result the target is not only heated but it explodes into tiny fragments which are then cleared by the body eventually. This is the way that the lasering of tattoos works.

A picosecond laser releases energy so fast that the effect become a predominantly mechanical one rather than one that involves heat. For this reason it is also called a photoacoustic effect. Because picosecond lasers release far less heat it is useful in darker photo (skin) types as it is less likely to cause collateral damage. These powerful lasers can also work on far tinier molecules and new evidence shows they can therefore clear tattoos faster and safer.

As the duration of the pulse decreases, typically the power of the laser increases. As a example picosecond lasers have power in the gigawatt range. One gigawatt lights all of London for one hour (but the time of delivery is much shorter). At the other end of the spectrum millisecond lasers often function in the kilowatt range

Q-Switch

Q-switch stands for quality switch laser. A Q-Switch is a high-energy nanosecond laser. These lasers use a different system of mirrors which allow energy to be stored and then delivered all at once. Because high energy is now delivered in a very short timespan it can achieve different effects to a traditional laser. A typical example is in treating tattoos. Whereas a traditional ‘long-pulsed’ laser would have simply heated up the tissue target resulting in a burn, a Q-Switch laser delivers far more energy to the target in a far shorter time, shorter than the target can dissipate heat. As a result (up to a certain size limit) the target fragments.

Bare Fibre lasers

There is a new and exciting development in laser technology, available at the Cadogan Clinic, is bare fibre lasers. These lasers use a single optic fibre thinner than the breadth of a hair which goes under the skin. The fibre is so narrow (less than the width of a hair) that minimal pain relief is needed. This expands the user of lasers to many more applications whilst sparing the skin itself. Such applications include microliposcultpure, where pockets of unwanted fat are targeted causing the body to absorb them over a short period of time (effective for double chin), non-surgical facelift (Endolift ®), keloids, neck-lift lines, wrinkles and some vascular lesions. Because these lasers operate under the skin they are also safe to use in darker skin types which could previously not be treated.

Plasma pen

A plasma pen makes use of an ionised electric arc that acts on the very surface of the skin from the tip of the pen. Without making direct contact with the surface. This ionised electric arc (plasma) vaporises the skin whilst tightening the surrounding area. The ionised electric are is composed of very high energy plasma (charged particles) which disrupts the integrity of the most superficial part of the skin. As the surface of the skin is vaporised, superficial pigment impurities are destroyed whilst the energy imparted from the plasma itself in form of heat causes skin tightening. Plasma has been described as the ‘fourth state’ when ionised particles are given very high energy they behave in different ways to standard solid liquid or gas. This high-energy causes an inflammatory response and the inflammatory response causes shrinking and eventually the deposit of collagen.

What can lasers be used for?

Lasers can be used for both therapeutic and aesthetic purposes, thought often these indications co-exist. Lasers are often used to treat difficult conditions, including as second- or third- line treatment when the original approach (e.g. medication or surgery) has failed. Laser is at the cutting edge of surgery and is increasingly used to treat complex conditions and complications of surgery for which there was previously no treatment. Laser surgery is therefore an area where keeping updated is paramount for the speciality.

A laser, in expert hands, can be used in multiple ways.

Therapeutic Uses

In a therapeutic capacity, lasers can be used to treat:

  • A variety of Scars such as:
    • Atrophic scars, which are sunken in scars such as acne or stretch marks:
      • Acne scars, (a complex problem often treated with a combination of treatments)
      • Stretch marks, which occurred for example after pregnancy or after some weight-loss. Areas that can be targeted include the thighs, arms and tummy
      • Some scars post surgery
    • Overgrown scars including hypertrophic and keloid scars which are a thick, wide, raised scar that occurs where skin has been injured. When treating these it’s normally combined with medication or a prescription that’s administered either at the same time as treatment or afterwards. Lasers can also be used to address particular symptoms after scars occur from surgery or burns. Some patients may have a feeling of itch, tightness and contraction where the scarring is. This can almost feel as though the skin is bound by a straight-jacket. Some lasers are very good at treating those kinds of symptoms by using fraction laser.
    • Burn scars
    • Post-surgical scars
    • Vascular anomalies
    • Some benign pigmented lesions such as seborrheic warts
    • Viral warts (using a combination of lasers)

Aesthetic Uses

Skin rejuvenation

Ageing is a predictable event which we all have to go through. However with the recent advances in laser technology this process can be slowed or at times reversed. Age changes to skin are closely related to sun damage and on the far end of the spectrum lies skin damage and disease. Therefore, there is an important interplay in prevention as well as treatment. Age changes in the skin can be broadly classified into pigment change; change in the structure of the dermis and sun-related damage to cells.

Colour laser (such as Nd: YAG) can be used effectively in various modalities to correct this colour change. This colour change can be due to pigment (such as benign sun spots – lentigo solaris), broken blood vessels in the skin (telangiectasia). On the other hand, lasers such as non-ablative fractioned (1470 nm) deliver energy to tissues, tightening skin; yet other lasers such as fractioned Co2 in various modalities can be used to resurface, tighten and lift. It is often necessary to combine these treatments in order to achieve the optimal results bearing in mind the nuances of personalised medicine described above.

The wavelength of Nd: YAG targets pigment, heating it, denaturing the molecule and causing the body’s immune system to absorb the pigment naturally. It is a well-known fact that unblemished skin appears and feels rejuvenated. On different settings, Nd: YAG can target broken veins. It heats up the blood in the veins destroying and clotting at the same time which are then reabsorbed naturally by the body, often with immediate results. Other wavelength will be used to achieve a similar effect depending on what the nature of the pigment and the background skin is.

Dermal regeneration can be achieved in a variety of ways. Non-ablative laser usually results in effective dermal regeneration over a number of repeat sessions, however because it does not destroy tissues (non-ablative) the downtime is remarkably low. On the other hand, ablative fractional laser (Co2) results in marked dermal regeneration over a far shorter timespan because more energy is imparted to skin there is also a higher downtime which is usually capped at 5-7 days. Energy imparted to the skin excites a controlled inflammatory response. Cells that make-up the dermis and maintain it are recruited to the area. Such cells include fibroblasts which lay down new collagen and eventually reorient it according to the grain of the skin. When collagen and other ground substances (e.g. elastin) are deposited this results in plumped, rejuvenated more elastic and youthful skin.

On yet another setting Co2 laser can be used to resurface the skin and this can include sun-damaged areas leaving behind in-tact dermis from which new skin grows. Considering that this skin is perfectly matched to surrounding areas, the aim of rejuvenation is achieved.

Epilation / Laser Hair Removal

A major application of lasers is in epilation. Laser epilation is commonly known as Laser Hair Removal. Epilation uses a concentrated laser beam to remove unwanted hair. The laser energy is absorbed by the pigment in the hair and the light energy is converted into heat, damaging the hair follicles and over time stopping the growth of hair in the treated areas.

Patients require multiple treatments to see lasting results with this procedure. Laser hair removal can require anywhere between two and eight treatments depending on individual characteristics and area focussed on. The time allotted between treatments will also depend on the location of the hair being targeted. On areas where the hair grows back quickly, such as upper lip or eyebrows, treatment can usually be repeated in 4-8 weeks. On areas where hair grows back slower, such as the legs or bikini line, areas may be treated again in 12-14 weeks.

It’s possible to remove unwanted hair in all areas with the exception of the eyelid and the delicate surrounding areas. Popular areas include legs, underarms, face and bikini

The procedure may be uncomfortable either during the laser treatment or afterwards, but your doctor can give you creams to help with any pain or discomfort.

Tattoo Removal

Lasers work well for tattoo removal. The process works by delivering laser energy to target the carbon particles or ink dyes in the skin, allowing for targeted, selective destruction of the foreign pigment while minimizing damage to any surrounding skin.

Over a series of laser sessions, tattoos are removed by the laser using energy to break down the tattoo into tiny fragments which are then carried out of the body via that bloodstream, as the immune system would carry out any other type of unwanted foreign object. Each laser treatment lightens the color of the tattoo until finally nothing remains.

This is a safe treatment when performed by an expert, and with the technological advances in lasers we are able to remove tattoos of any ink color. There are some challenges involved due to different skin colors, which is why it’s important to have your tattoo removal performed by an expert with years of successful treatments completed.

The treatment time varies for different types of tattoos, different colors and factors such as how deep the tattoo was applied into the skin.

The Kirby Design Scale is designed to tell you how many treatments you will need for your tattoo to be removed. This is determined by several factors including skin tone, ink quality, how much ink is done, how many layers of ink, where in the body the tattoo is and so on.

Combined laser procedures

The Cadogan Clinic has the advantage of world-leading experts in surgical and laser fields who collaborate together offering a range of combined surgery and laser procedures. This level of collaboration is unparalleled in the UK and brings about distinct advantages, combining

  • the power of surgical technique with the refinement of laser
  • the skillset of two consultants

The advantages include

  • reduced operating time
  • reduced downtime
  • improved outcomes
  • longer-lasting results

The joint procedures can either be done in tandem (i.e. laser – surgery – laser) or simultaneously (laser + surgery).

For example

  • surgical blepharoplasty and laser brow lift
  • surgical brachioplasty (bingo wings) and laser tightening
  • hand rejuvenation – surgical fat transfer and laser rejuvenation (age spots)
  • Breast and décolletage – surgical fat transfer and décolleté rejuvenation with laser/airjet.

Section 2 - IPL

IPL is a different form of high-energy treatment to laser, standing for Intense Pulse Light. Whilst laser is a pure single wavelength, IPL makes use of normal light which a system of filters. IPL is therefore a range of wavelengths which has different uses and can treat different conditions. 

How does IPL work?

IPL has different properties to laser. In Unlike laser light it is non-colinear and non-collimated and polychromatic. This means that the waves of light are not necessary parallel, they do not necessarily travel in sync and a range of wavelengths are present, dependent on the selected filters. Due to these properties, IPL tends to treat larger surface areas and also works more superficially (skin layers) than lasers.

What is IPL used for?

IPL handpieces typically use a larger crystal and need a contact gel, both for comfort and to improve delivery of the wavelengths to the skin. As IPL consists of a range of wavelengths it can targets multiple colours in the lesion/treated area at once. For example, you might notice that when IPL is used for epilation, very fine superficial veins may also disappear since their wavelengths are very close.

As IPL is less specific to a particular colour, care is needed to prevent the IPL from also targeting normal skin colour and a skillful IPL operator will select the appropriate settings on this basis.

Uses of IPL

IPL can be used to perform epilation, treat rosacea, treat superficial spider veins and also some forms of skin pigmentation.

It is possible to get very low strength IPL over the counter for hair removal but IPL in specialist hands is much stronger and therefore effective.

Section 3 - Radiofrequency

Radiofrequency skin tightening uses radiofrequency (RF) to impart energy to tissues in the form of heat. This energy stimulates collagen and elastin production therefore reduces the appearance of loose skin. Radiofrequency is at the far end of the electromagnetic spectrum with longer wavelengths and this property can be harnessed to produce an effective, non-invasive modality. The useful range is in the radio-wave range, between 1MHz and 10GHz.

How does Radiofrequency work?

Different types of tissues present different resistances to the radiofrequency and heat is generated on this basis. However, energy passes right through the most superficial layers of skin leaving them largely unaffected and the heating takes places mainly in the deeper aspects. This modality is particularly useful in causing change to the fibrous septae that anchor skin to underlying muscle across the fatty layer that runs in between. By tightening the septae, radiofrequency causes and improvement in skin tightness. Time between treatment is not less than seven days and light edema (swelling) is expected for the following day.

What types of radiofrequency are there?

Radiofrequency can be delivered in various forms:

  • Fractioned or non-fractioned
  • Unipolar, bipolar, multi-polar (number of electrodes used)

What is Radiofrequency used for?

Typically, the areas treated are the lower side of the face, the arms, the thighs and the abdomen as well as the lower neck. On a different aspect, radiofrequency can be delivered through probes to target particularly structures. Such structures include veins, such as the varicose veins in the lower limbs and also nerves (pain control).

Radiofrequency can be used for body contouring, cellulite improvement and reduction of some wrinkles.

Section 4 - Other Energy Devices

LED Light

LED light makes use of near infra-red energy (NIR energy). This is non-ablative low energy that is purported to trigger natural healing cell processes stimulating rejuvenation and repair.

  • Red LED light stimulates cellular activity. This helps to boost collagen production and therefore minimizing fine lines, wrinkles and stretch marks, as well as boosting the plumpness of your skin.
  • Blue LED light stimulates the destruction of acne bacteria, called Propionibacterium, and therefore is a good method for treating mild to moderate acne breakouts.

One particularly use of infra-red light is to activate medications including substances used to both treat skin cancer, pre-cancerous skin whilst at the same time achieving a rejuvenating effect. For example, methyl-amino-laevulanic (MAL) acid. MAL is an anti cancer cream that is applied to some forms of skin cancer or precancerous skin. MAL is absorbed by the target cells but not by normal cells. After a period of incubation, LED may be used to activate MAL which destroys the target cells selectively. A brand name is Metfix.

LED treatments are delivered on a repeat basis, normally with a protocol of 4-6 treatments, with a one or two week space between each session. Afterwards, you can have a touch up treatment performed every few months.

Ultrasound

Ultrasound is commonly known as a diagnostic test but can also be used to deliver heat through soundwaves to simulate collagen deep in the skin without impacting the epidermis.

Ultrasound therapy can be used to treat moderate ageing problems such as sagging skin, wrinkles and boosting collagen production.

High-intensity focussed ultrasound

High-intensity focussed ultrasound (HIFU) is a technique that imparts ultrasound energy. This energy is converted to skin tightening through the bodies own natural processes and however ultrasound will target deeper tissue. The handpiece is convex, allowing the operator to target the ultrasound at different depths, leaving the more superficial layers of skin unaffected. For this reason HIFU is often used to target muscle just underneath the skin. This causes multiple points of controlled damage that boost collagen production. As the muscle tightens this causes soft tissue to lift up. The technology is often used for tightening neck, décolletage, eyebrow and fine lines. The most effective brand of HIFU is called Ulthera, the treatment called Ultherapy, and this available at the Cadogan Clinic

After receiving an ultrasound treatment you will continue to see results appearing for three to six months. One treatment alone is normally enough, however some patients may be advised to have one to three sessions in order to see their desired results.

Airjet (Jet Volumetric Remodelling)

Jet volumetric remodelling (JVR) is state of the art technology, which uses a needle-free system to simultaneously deliver mechanical energy and a healing compound under the skin with minimal downtime. The mechanical energy delivered, the volume of the substance delivered and the depth at which it is deposited can be very accurately controlled. The combined effect of the mechanical energy and the medications delivered induce optimally desired effects in a variety of important skin conditions.

A powerful jet of compressed air blasts compounds into the skin causing a controlled microtrauma and micro-cavitation (creating small spaces) whilst the injected material spread optimally from the point of insertion laterally. Compared with traditional needle injections this results in a far less painful procedure and because the jet disperses the medication much more evenly it can cover 100 times the area of an injection whilst leaving minimal signs visible on the skin.

The effect of the microtrauma and the medication is synergic (works together) to set in motion the bodies own healing systems, ultimately regenerating the skin in an effect that is often permanent.

This has proven to be effective in

  • Stretch marks - where a particulate mix of hyaluronic acid is delivered
  • Acne scars
  • Atrophic scars

The technique can also be used to address hypertrophic scars and keloid scars by delivering other substances e.g. steroids

Yet other cutting edge applications include delivery of botox for excessive sweating in a far less painful manner than traditional injection using needles.

The versatility of the system is underscored by a skilled operator, who by focussing more on the energy delivery can use the system to deliver an effective browlift without any surgical scars
A skilled operator can also adjust delivery settings whit hyaluronic acid (HA) (as with dermal fillers) to delivery immediate hydration to the tissues to plump up the dermis and improving the appearance of the skin. This effect will subside over time, as the effects of HA are only temporary, leaving behind the long-term boost in collagen production. As the system delivers mechanical rather than heat energy it is safe to use on all skin types and all skin colours, all year round.

Heat and Cold Therapy

Heat and Cold therapy both utilise energy to induce lipolysis in the body’s tissue (the destruction and depletion of fat cells). They are both non-invasive body contouring treatments that don’t require any downtime. Whilst they both work to reduce and remove fat cells, they have different energy modalities that treat fat in different ways.

Heat Therapy (Sculpsure)

Heat therapy uses laser technology to melt fat cells away using heat, as opposed to the cold therapy used in CoolSculpting. The heated laser is delivered through a belt that uses specific wavelengths to heat up and eliminate fat cells. Heating the fat cells kills them, and the dead fat cells are then carried out through the liver in the same manner that CoolSculpting eliminates the dead cells. The body’s lymphatic system naturally flushes out any dead cells over the course of the next 12 weeks following treatment.

Cold Therapy (CoolSculpting)

Cold therapy, called cryoliplysis,freezes fat cells causing them to slowly die. Fat is placed between two panels that freeze the fat. Frozen fat cells are then considered dead, and all dead fat cells are excreted out of the body via the liver. The fat is selectively damaged, without damaging the skin. This process of elimination takes several weeks, and you can see results up to three months after treatment.

Section 5 - Laser Safety

Safety Standards

There are two classes of laser safety standards which are used internationally:
International Electrotechincal Commission (IEC) 60825; which has been adopted in the UK as the British Standard BS EN 60825-1:1994 “Safety of Laser Products. Part 1 Equipment classification, requirements and user’s guide.”
American National Standards Institute (ANSI) Z136

The objectives of the Standard are to protect people from laser radiation, reduce possibilities of risk or injury, ensure adequate warnings of hazards and lay down requirements for user and manufacturer to establish procedures.

Limits have been set for exposure to nearly all types of laser radiation, which are referred to as Maximum Permissible Exposures (MPEs). MPEs are the safe levels of exposure which a person can be subjected to without suffering any negative effects. MPEs are distinguished by the wavelength of the individual laser and the duration of exposure.

Engineering Safety

Engineering controls have been established to remove the necessity of following laborious procedures as well as diminishing the possibilities of failure of personal protection equipment. The engineering of the laser allows the safety features to be built into the laser equipment.

Some examples of Engineering safety controls are:

  • Remote interlocks
  • Key controls
  • Beam enclosures
  • Protective filter installations

Administrative Safety

Administrative controls are established alongside procedural controls in order to supplement engineering safety. This ensures that the expert and any persons using the laser are protected from laser hazards.

Some examples of Administrative safety controls are:

  • Proper signage
  • Safety protocols
  • Proper training and instruction
  • Regular maintenance and servicing

Protective Equipment

Personal protective equipment (PPE) should be used to protect both the technician and the patient from any laser hazards. Depending on what type of treatment is being performed, there are various types of eye protection used, and on rare occasions, protective clothing may be used.

Laser eye protection is based on several factors including the wavelength being used for treatment, the MPE, visible light transmission requirements and adequate vision.

Laser Protocols

With any laser there are protocols that are developed and implemented before use. Protocols include important factors such as the use of a specific laser, a designated area for use, type of laser being used for treatment, training of the technician and the use of personal protective equipment.

Section 6 - Laser Selection

Choice of Laser

How to choose the right laser

It is striking from the above sections that the choice of laser depends on many dimensions including the type of patient skin, the medical condition of the patient and the tissue that needs to be targeted as well as the desired effect (this is one facet of personalised, precision medicine). Your laser specialist will be able to go through these various considerations with you to make a join decision regarding which laser is best used and when, also taking in consideration your personal circumstances including availability and downtime.

Inherent to this discussion is the availability of the right type of laser for your requirements.
It is therefore crucial for a wider range of lasers to be available from which to choose from in order to effect the most appropriate and tailored treatment plan.

Laser Treatment regimes

Laser is never a one-off treatment and the best results are often achieved through multiple treatments. This will require a specialist to put together a protocol of treatments that allows for enough time for the desired effect to be achieved, as well as allowing enough time between sessions for the skin to recover. 

Skin type

Skin type plays an important role in determining the success of laser treatments. For example for hair removal, laser works best on black hair on white skin. Black hair on black skin can also be treated thought risks or complications will increase. Some colors by nature are difficult to treat, such as red hair due to its chemical structure of the red hair. A particularly useful way to analyse skin depends on its ability to tan and/or burn after exposure to natural light. Classically, skin type falls into skin categories ranging from white skin (never tans, always burns) to black skin (never burns, always tans). Whilst this classification is not the most thorough and at times is debated it is a really useful classification which allows the operator to tailor settings such as power and wavelength to avoid side-effects and optimise treatment effectiveness.

Preparing for a laser session

Medication

When preparing for a laser session it’s important to discuss any medications you’re taking with your surgeon to ensure that nothing you’re taking interferes with the treatment. Such medications include some forms of antibiotics, Accutane and retinoic acids. Studies have shown that laser is contraindicative when these medications are being used, showing that the skin doesn’t heal as well after treatment. Although this debate has been ongoing for some time now, this is best discussed with your specialist.

Its also important to tell your specialist if you are currently on any medications: some might cause an unwanted reaction with sunlight.

Make-up

You will need to remove any and all make-up before having a treatment with any types of laser. Make-up has sources of color in it and can interfere with the laser. In the summer months, it’s important that you do not apply any type of sunscreen to the areas being treated for at least 24 hours prior to treatment.

Tanning

It’s important to note that if you have any type of tan to your skin, because the laser will pick up the pigment from the tan instead of the pigment that we are targeting. It is a bad idea to get a laser treatment if you’re planning to get sun tanned the day after or if you’re planning a vacation or trip to the beach etc. Un-tanned skin is the best to be treated with laser.

Skin preparation regimes

For patients with dark skin types, particular skin preparation regimes may be appropriate and therefore together with a test patch and a consultation means that there is a process put in place.

Section 7 - Aftercare

Adhering to your specialists’ recommendations on aftercare including attention to regular sun protection and moisturization is vital both to ensure success of treatment, and to avoid complications. Failure to follow the regime set out by your doctor can result in some risks and even damage.

Sun exposure post treatment

Patients should minimise sun exposure after laser treatment. Any treatment that imparts energy to skin may, to varying degrees, cause an inflammatory response. Inflamed skin reacts differently to sunlight and may causes post-inflammatory hyper pigmentation (PIH). For this reason, putting on SPF 50+ once every two hours when out in the sun, and once a day if staying mostly indoors is very important.

Skin care post treatment

Depending on what lasers you used, you may find that your skin peels or sheds. This is common occurrence and you will be put on antivirus medication if areas near your lips are treated, and sometimes antibiotics or antifungals depending upon the case.

Other components of aftercare required in individual circumstances include skin moisturization, rigorous application of sun protection, and other topical or oral medications.

Section 8 - Results

Results

Often, the skin will continue to improve in the treated area as time passes, and those effects are often permanent. For example, with a laser facelift, this improves the laying down and creation of new collagen, tightening the structures and improving epidermal turnover over time. Depending on the laser type, it an take away the impurities too.