Laser surgery has taken gigantic steps forward in recent years and the use of medical lasers in dermatological surgery is a technique of great value. A laser is a device producing an intense beam of light, visible or invisible, which can be focused on a small area. Laser beams are different from x-rays in that there is no ionizing radiation in the beam of light of lasers. www.class.ca

Main advantages :

Main advantages of CO2 laser surgery:		Main advantages of selective photothermolysis lasers:
Instantaneous hemostasis of blood vessels smaller than 0.5mm, enables the use of this laser without danger to treat hemophiliacs and patients receiving anticoagulants. Sealing of lymphatic vessels theoretically reduces the risk of dissemination from potentially malignant cells. Absent or diminished post-operative pain (due to sealing of nerve endings, absence of inflammation, little swelling and little drainage). A sterile operative field reduces the risk of disseminating infection. Smaller chances of hypertrophic scars or keloids compared to conventional surgery. Fewer physical manipulations of tissues during surgery. Clearer view of operative field (no obstruction from instruments nor blood). It is often possible, in one or two operative sessions to complete a treatment that otherwise would have required several additional visits to the doctor or even hospitalization. Local anesthesia is usually sufficient. As with any surgical procedure, some complications are possible following CO2 laser therapy. These may include pigmentation changes (hypopigmentation or hyperpigmentation), hypertrophic scarring or keloids. However, most of these problems are reversible with time or treatments. Despite this, patients presenting very pigmented skin or a history of bad scarring could be excluded from CO2 laser treatments.		These lasers provide the most up to date treatment available for the removal of vascular lesions, some benign pigmented lesions, tattoos and also for hair removal. Hence they remove different types of lesions that cannot be removed through conventional surgery (on account of unacceptable scarring). Lesions are removed with minimal pain (no anesthesia is required for most patients) with no or minimal risk of scarring ("temporary" hypo or hyperpigmentation may occur). However, many treatment sessions may be required to obtain maximal blanching of some lesions.

Let it be said that lasers have been in medical use for over forty years and that there has not been any report of long term adversed effect or development of cancer.

12 types of laser are now being used in our office surgery unit:

Thermally Designed Lasers:		Selective Photothermolysis Lasers:
CO2 laser CO2 SilkTouch laser CO2 FeatherTouch laser Erbium:YAG laser Con Bio Sciton (Contour™)		Candela Vbeam Dye laser Aura KTP Q-Switched Ruby (Sinon) Nd:YAG Palomar Lumenis ONE™ Universal IPL Multi-Spot Nd: YAG LightSheer Diode Sciton Profile Contour™-Erb: YAG ClearScan™-Nd: YAG ThermaScan™-1319-nm

The CO₂ Laser:
has the capacity to vaporize cells. The infrared energy is absorbed by the water contained in the cells, and this results in tissue destruction with a loss of substance. When focused, the CO₂ Laser acts as a scalpel. When defocused, it is used to vaporize skin lesions.

Lasers Erbium:YAG (Con Bio or Profile/Contour™):
This new and revolutionary Erbium:YAG laser allows us to resurface the skin of the face, neck and back of hands by removing the damaged surface layer of dead skin cells. This laser removes fine lines and wrinkles and minimizes acne scars.

The CO₂ SilkTouch Laser or CO₂ FeatherTouch Laser:
These lasers allow us also to resurface the skin of the face. They remove fine lines and wrinkles, improve frown creases and minimize acne scars.

The IPL(HR) Lumenis ONE™, the Sciton Profile/ClearScan™ Nd:YAG and LightSheer Diode lasers:
These lasers were developed for hair removal. The light emitted by these lasers is absorbed only by the pigment located in the hair follicle, that which disables the follicle and prevents the transfer of excess heat to the skin surrounding the hair follicle. The LightSheer Diode is most appropriate for dark hair in fair-skinned men or women. The Profile/ClearScan™ Nd:YAG laser is a new comer to our office. This laser, with a contact cooling device, is used for hair removal in darker skin patients. The IPL (HR) de Lumenis ONE™ allows us to treat all types of skin, all colors from blond to black, all skin texture: fine,coarse, dense and all sizes of hair. (www.lumenis.com) (www.sciton.com)

The Dye Laser (Candela Dye Vbeam):
is a selective photothermolysis laser to treat cutaneous small blood vessel disease processes (telangiectasia, port-wine malformation, certain types of warts etc.). This highly selective destruction of blood vessels occurs with preservation of the perivascular area (less thermal coagulation due to its short pulse duration) and with very little action of this yellow light on the pigmented skin surface (no significant absorption by melanin). This laser, to which is attached a cooling spray ("Dynamic Cooling Device"), is also a natural complement to sclerotherapy of lower extremities to treat effectively small vessels under one mm in diameter.

The Aura KTP Laser:
is a laser to treat vascular lesions (facial and leg telangiectasia). It is used with the fiber pen for the manual treatment of linear lesions and also with a SCANNER for the treatment of larger vascular lesions (a CoolSpot is also used when indicated).

Two other lasers are used to fragment pigment:
Q-Switched Ruby or Nd:YAG laser.
The indication to use one or the other varies according to the type of pigmented lesions or the color of the tattoo. Hence it is possible to safely, easily and effectively remove most types of decorative, medical and traumatic tattoos without scarring. These lasers are also used to treat superficial and deep pigmented lesions including everything from freckles, to age (actinic) spots, café au lait macules, junctional pigmented naevi and some pigmented birth marks (congenital pigmented naevus).

Laser Sciton Profile/Contour™ Erbium:YAG:
The Profile/Contour™ Sciton Laser is a new generation of invasive Erbium:YAG Laser.
The MicroLaserPeel is the awaited missing link between microdermabrasion and carbon dioxide laser. For the treatment of superficial wrinkles, the rejuvenation results obtained are comparable to those of a CO₂ laser without the inconvenience of a long time off. It allows a uniform and control clean vaporization selecting from 10 to 50 microns. The down-time is short, 2 to 4 days, so called the week-end wrinkle laser, according to the depth of the ablation because the MicroLaserPeel does not penetrate the 110 micron epidermal barrier. This treatment may be unique or repeated at intervals of 2 months, but results are not additive.

This same laser, however, performs another function which is similar to that of carbon dioxide lasers. The results obtained are similar, but on account of the precise independent control of ablation depth and thermal zone by a high speed computer-guided scanner (LAPG Telecentric), the down-time is shorther and the post-op care is much easier. The Profile/Contour™ is used to treat deeper wrinkles, epidermal lesions and acne scars.

Sciton Profile/ThermaScan™-1319 Laser-nm:
Is a non-ablative system of the fourth generation.
This laser at 1319-nm wavelenght has been designed to allow a controlled heating of subepidermal layers of the skin. The LAPG computer-guided high-speed scanner coupled with full contact cooling technology means a short operation that treats all skin types, is safe for tanned skin, no hyperpigmentation and a wide range of application: Collagen remodeling: Photorejuvenation, Wrinkles, Acne scars. Heating of sebaceous glands for acne treatment.