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									International Congress
“Therapeutic Innovation of Dermatology & Dermato-cosmetology”
October 22nd-25th 2004, Shangri-la Hotel, Bangkok, Thailand

Present and Future of Laser, Intense Pulsed Light and Radiofrequency
                      Prof. Niwat Polnikorn, MD.
                      Clinical Professor in Dermatology
                      Skin Laser Center
                      Ramathibodi Hospital and
                      Kasemrad Aesthetic Center-Prachacheun
                      Bangkok, Thailand

Laser surgery and treatment have been introduced into dermatologic practice for more than 30
years. The first generation of lasers is high power continuous wave for surgery e.g. carbon
dioxide and Nd:YAG. Today these lasers are still being used for certain procedures e.g. nail
surgery, excision of vascular tumors, blepharoplasty. Under experience hands, the result is
generally much superior to other method of surgery. The second generation of lasers had been
developed after introduction of the theory of selective photothermolysis by Anderson and
Parrish in 1982. Fixed pulse-width pulse dye lasers (577, 585 nm) have now been replaced by
variable pulse-width pulse dye laser (595 nm) as the standard treatment of hemangioma. Q-
switched ruby (694 nm), alexandrite (755 nm) and Nd:YAG (1,064 nm) have been introduced
for the treatment of hyperpigment disorders and the removal of tattoo and are presently the
treatment of choice for dermal melanocytic lesion (Nevus of Ota, Acquired Bilateral Nevus of
Ota like Macules) and for the removal of tattoo. Laser resurfacing with high energy pulsed or
flash-scan carbon dioxide laser were introduced for facial resurfacing of photoaging and
atrophic scar. Even though degree of improvement is acceptable, late side effects, especially
hypopigmentation, discourages further use of this technique. Erbium:YAG laser which was
introduced for facial resurfacing had less complications but was also less effective. The third
generation of lasers which has been introduced recently is non-ablative laser. By using the
long pulsed infrared lasers (1,064, 1,320, 1,450 or 1,540 nm) together with cooling device, it
is possible to stimulate neocollagenesis in the dermis without damaging of epidermis. These
lasers have been proved to be moderately effective for the treatment of wrinkles and shallow
atrophic scar. Long-pulsed diode (800 nm), alexandrite (755 nm) and Nd:YAG (1,064 nm)
have been shown to be effective for permanent hair reduction. For dark skin patients,
epidermal cooling to prevent burn is essential. Small spot size (1.5-3 mm diameter high
energy long-pulsed Nd:YAG laser with epidermal cooling device is effective for management
of dilated veins (<3 mm. in diameter). Introduction of broad band intense pulsed light (IPL)
system has been found to be effective for management of photoaging in Fitzpatrick’s skin
type I-II. It is also effective in permanent hair reduction and management of dilated veins and
scars especially in the similar skin types.

Recently non-ablative radiofrequency face lift has been introduced, the early few reports
confirmed effectiveness of recontouring of cheek, eyelid and neck laxity. The author has
pioneered the use of superpulsed wave form (SuperpulseRF, PBC-EPEM, Thailand). The
preliminary result has shown promising result. The advantage of this technique is its lower
energy, highly repetitive pulses which do not require topical anesthesia. Long-term
effectiveness is being evaluated.
The development of medical cutaneous laser has now reached the plateau stage. Carbon
dioxide laser should be the workhorse of surgical laser for many years to come. For laser
resurfacing, development of thermal mode Erbium:YAG with more collagen stimulation will
proved to be laser of choice for laser resurfacing. Variable pulse width pulse dye laser will
continue to be the treatment of choice for hemangiomas same as Q-switched Nd:YAG, ruby
and alexandrite,\ which continue to be major pigment and tattoo lasers. Long-pulsed Nd:YAG
laser will be proved to be the treatment of choice for dilated veins and hair removal in
Fitzpatrickis skin type III-V. Intense pulsed light should be used only for treatment of
photoaging and permanent hair removal in Fitzpatrick skin type I-II. Radiofresquency
treatment either face lift, collagen stimulation, coblation is the treatment with most likely
possibility for much improvement in the near future.

                                            This research has been supported by
                                            Photo Bio Care Co., Ltd. Thailand
                                            224/2 Muangthong Thani, Bondstreet Rd.
                                            Pakkred, Nonthaburi 11120, Thailand
                                            Tel: 662 960 1151-4
                                            Fax: 662 960 1150

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