Principles and Practice of Cutaneous Laser and Light Therapy

Laser technology has evolved rapidly in the last 2 decades. The theory of selective photothermolysis guides the proper selection and use of lasers to safely and effectively treat patients. This review summarizes the basic concepts and adjustable parameters for laser devices, emphasizing the importance of selective photothermolysis in clinical practice. It then covers the clinical applications of laser devices, including vascular lesions, hair removal, tattoo removal, facial rejuvenation, and fractional resurfacing. The authors intend to make the reader feel comfortable with the proper selection and application of lasers to treat their patients.

Key messages

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Many different lasers (light amplification by stimulated emission of radiation) can be used to treat patients. The concept of selective photothermolysis guides the proper selection of laser wavelength, fluence, and pulse duration to selectively treat a target while minimizing damage to the surrounding tissue.
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Vascular lesions (vascular malformations, telangiectasias, rosacea) can be effectively treated with pulsed dye lasers (PDLs) (585–595 nm). Alternatively, diode (810 nm) and long-pulsed alexandrite lasers (755 nm) can also be used.
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Laser hair removal can be safely and effectively performed in nearly all patients. Options for laser hair removal include long-pulsed alexandrite (755 nm), diode (810 nm), and long-pulsed Nd:YAG (1064 nm) lasers.
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Pigmented lesions and tattoos can be effectively treated with Q-switched lasers. The ideal wavelength to be used depends on the color and depth of the pigment.
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Laser skin rejuvenation and resurfacing can be accomplished with many different devices. The newest technologies are fractional technologies, which treat only a portion of the skin surface, thereby potentially minimizing the downtime and side effects.

Lasers and light sources have offered unparalleled advances in dermatologic therapy in the last decades. Laser therapy has evolved rapidly from the first ruby laser in 1960 to the numerous different technologies that are available today. As the number of lasers available has increased, so has the need for a full understanding of the technology underlying these devices. In order to offer patients the best and safest treatment options, it is necessary to understand the technologies and theories behind the lasers. With this knowledge, it is then possible to select not only the proper laser but also the ideal settings such as energy fluence, pulse duration, and cooling. This article discusses the basic concepts of lasers and light sources as well as the indications for their usage.

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