Details: Laser Treatment of Pigmented Lesions
How does the laser work?
The laser emits an intense beam of light that is directed toward superficial pigment. Lesions such as lentigines (brown age spots) or café-au-lait macules (brown birthmarks) absorb the laser energy much more than the normal skin. This lets the laser remove these lesions without harming the surrounding skin.
What does treatment involve?
The physician or technician uses the laser hand piece to pulse over the lesions. Treatment time depends on the number and size of the lesions being treated. A single small brown spot takes only a few seconds. Treating many spots on the hands or face can take up to fifteen minutes.
Does treatment hurt?
The patient will experience mild discomfort or a hot tingle with each treatment. Numbing creams are rarely necessary. Within a few minutes the treated areas can become mildly sensitive or itchy. An ice pack applied for a few minutes can minimize this minor discomfort.
What is the recovery time?
Treated areas turn white immediately. Within minutes, the white color changes to red and then a red-violet thin crust forms. These crusts fall off in a few days on the face, but can last about two weeks on the arms and longer on the legs. A slight pink discoloration under the crust remains and fades slowly over one to three months depending again on the site.
How many treatments are necessary?
The majority of patients achieve satisfactory lightening or removal of the lesions after one treatment. A touch up treatment one month later can be helpful for the occasional stubborn lesion. Birthmarks are less predictable, but usually require two to three treatments.
How long do results last?
Results can last for years, but recurrence is always possible and relates directly to sun exposure. Protective clothing, avoidance of midday sun, and use of sunscreens can prevent recurrences. Topical creams containing 4% hydroquinone are helpful during the summer months.
What are the other risks?
Hyperpigmentation (darkening) and hypopigmentation (lightening) of the skin are possible and depend on the patient’s natural pigment. The risk is less than five percent for lighter skin patients. Darker skinned patients are more likely to have adverse reactions. Bleeding, infection, and scarring are very rare. As with any medical or surgical treatment, unforeseen consequences are always possible.
How are risks minimized?
Pretreatment use of rejuvenate products such as alpha hydroxy acids and retinoids will help the thin crusts shed faster. Start laser treatments when your skin is at its palest to minimize the risk of pigment abnormalities. Bleaching creams with hydroquinone help reduce the risk of hyperpigmentation.
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