Laser and Radiofrequency Treatments

Laser is not used only for aesthetic purposes in plastic surgery. It can also provide important solutions for many medical requirements.

Laser technologies, which can target a single focus without scattering, are absorbed by target substances of certain colors in the body, causing the destruction or rearrangement of these pigments.

Laser, which consists of a monochromatic light beam whose wavelengths can be changed, is used in various fields in medicine and especially in plastic surgery .

In plastic surgery, it can be used for disease treatment purposes such as the treatment of benign masses of blood vessel origin (such as hemangioma, vascular malformation), fading of scars, treatment of superficial skin lesions, and removal of tattoos.

The way laser devices send the laser beam can be continuous or pulsed. These two types differ in terms of the recovery time (thermal relaxation time) of the applied tissue after contact with the laser beam.

Lasers used in plastic surgery vary widely depending on their wavelengths and the medium used. The medium that makes up the laser can be solid, liquid or gas. Accordingly , the main laser types used in plastic surgery are carbon dioxide, neodymium-ytrium YAG (Nd-YAG), KTP, ruby (Q-switch ruby), erbium YAG, diode, alexandrite, green dye flash lamp, yellow dye ( pulsed yellow dye laser) is like helium-neon.

Contrary to popular belief, laser technologies are not safe or without side effects. Therefore, our patients should receive the support of a plastic surgeon in all applications related to laser devices, including epilation-type interventions . Otherwise, problems such as burns, deeper or swollen scars, and lingering tattoos will not be a surprise.

Before applying laser treatment to the "moles" on your body, be sure to get advice from a plastic surgeon or dermatologist. Your moles may not be suitable for laser treatment. It is recommended to diagnose them by biopsy first.

Intense Pulsed Light (IPL), which is thought to be a laser but does not contain a real laser technology , is concentrated light pulses that target and evaporate different color receptors depending on the filter used in lights with wavelengths between 400-1200nm. It is mainly used for light colored (blonde, brunette) hair roots.

Laser can be used in skin rejuvenation procedures in the same session as face lift surgeries. This treatment also provides treatment for wrinkles that cannot be overcome in face lift surgeries, although rarely.

Face and neck lift surgeries basically aim to eliminate deep folds and sagging skin. Facial skin has a very rich network of blood vessels and is therefore quite durable. At the end of facelift surgeries, it is possible to eliminate resistant fine wrinkles with fractional laser applications. I explain in detail that there will be a wound healing process after surgery in these patients.

When lasers are used to clean hair follicles, they can cause serious skin burns in inexperienced hands, even though they contain cooling systems.

Laser epilation , which is perhaps the most preferred laser treatment for the skin, works by creating regression (atrophy) in the hair follicle after a certain number of sessions. In fact, since the hair itself is the main element that allows the laser to be absorbed, the thicker the hair diameter, the higher the probability of the laser affecting it. However, the bristle diameter problem has been largely eliminated in state-of-the-art devices.

For my patients, especially women, who complain of excessive hair growth, I first ask for the opinion of an endocrinologist to investigate a possible hormonal imbalance. For example, some pituitary tumors and ovarian cysts and tumors can cause an increase in the amount of hair.

Laser hair removal is generally not very reversible if the sessions are completed properly. Therefore, it provides more effective results than chemical or mechanical epilation applications.

The most commonly used epilation lasers are the alexandrite type. Although these also have a cooling system, they can rarely cause serious burns. Therefore, I recommend the application under the supervision of a competent plastic surgeon or dermatologist.

Laser technologies are also used successfully in the treatment of vascular tumors such as hemangiomas.

Hemoglobin, which is located in the red cells in the blood and is responsible for carrying oxygen by giving the blood its red color, is one of the main targets of some laser devices. Hemoglobin is also an effective target for lasers in vascular lesions such as hemangioma. Laser light is absorbed by hemoglobin, causing local temperature increase. Since the blood passing through the mass undergoes clotting, the hemangioma cannot be nourished and shrinks over time.

Likewise, laser is used successfully in other tumors of vascular origin.

A certain color sequence is followed depending on the device used in laser tattoo treatment. It is not possible to eliminate all color pigments in the same session. A certain healing process is required.

One of the targets of laser light is dyes of various color tones. When tattoo inks are applied by machine, they generally settle at approximately the same depth under the skin. This depth may vary in handmade tattoos. Therefore, the effectiveness of laser is better in machine tattoos. Laser beams are absorbed and broken down by the dye, and are digested and eliminated by immune system cells. Laser beams of different wavelengths are used for each dye. Therefore, it is not possible to remove all color tones at the same time. In addition, there will be a healing process on the skin after the application, which may take more than a week.

After laser deep peeling, a peeling and wound healing process begins, which can take approximately 10-15 days. Patients should be patient during this process and follow the recommended mask and medication applications.

It may be possible to improve skin quality, eliminate fine lines and increase dermal thickness with laser during facial rejuvenation surgeries or before or after the surgeries. In this case, there will be peeling and crusting during the healing process of the skin. This is equivalent to the result of deep chemical peeling applications. During this period, I recommend my patients a mask and supplements that both accelerate epithelial formation and protect against infections. Regular use of these and, as I always say, stopping smoking will shorten the healing process.

Laser is not a form of treatment without side effects. As mentioned, burns may occur, as well as permanent and undesirable color changes on the skin (dark or light color), scar formation and swelling (hypertrophic scar).

The laser's ability to create focused heat can cause burns in inexperienced hands. Therefore, I recommend that this procedure be performed under the supervision of a plastic surgeon. One of the possible late effects of laser is color changes in the application area. This change may occur in the form of darkening (hyperpigmentation) or lightening (hypopigmentation). Darkening is mainly due to post-application sun exposure and can be removed by some lightening chemical applications or mechanical scraping with microdermabrasion. The lightening of the color is related to the insufficiency of the activity of the melanocyte cells that provide color in the area, and this activity can be largely eliminated by some spreadable drugs.

In deep focused laser applications, the wound healing process on the skin will begin. In some patients, this wound swells as it heals and may extend beyond the limits of the wound. In this case called hypertrophic scar, successful results can be obtained with cortisone injections. Again, silicone gel applications can provide thinning by reorganizing the collagen in the scar area. Therefore, I ask patients who come for laser application to show their scars if they have had a previous injury or surgery. Patients who have previously developed hypertrophic scars should take the possibility of the scar to swell if they are going to undergo surgery or laser application.

Laser is not used only for aesthetic purposes in plastic surgery. It can also provide important solutions for many medical requirements.

Laser devices have a wide variety of usage areas depending on the technology they contain. Although it is used in many fields of medicine, plastic surgery constitutes one of the largest fields. Some of these can be exemplified as follows;

Laser-assisted fat removal (liposuction)
Epilation
Skin wrinkles (after 1 month of retinoic acid or hydroquinone treatment)
Telangiectasias (vascular dilations)
Lentigines
alopecia areata
psoriasis
Vitiligo
atopic dermatitis
leucoderma
Neurofibromatosis (small lesions)
Silendroma (and Turban tumor)
actinic keratosis
Deep and large warts
Sebaceous nevus (Jadahsson)
Lymphatic malformations
Dermal pigmented lesions (Ito, Ota nevus, cafe au lait)
Epilation
Spider veins and varicose veins (especially intravenous administration)

It has been shown that radiofrequency treatment works by making changes in the collagen structure of the tissue with the increase in temperature created by radio waves in the tissue (1-8). It has also been demonstrated that when temperature increases affect deeper layers, it can cause thinning of fat tissue (1,2).

Radiofrequency is a technology that works by heating the tissue with vibrations of a certain frequency created in an electromagnetic field. In experimental studies on this technology, which is the subject of various studies, reductions of up to 70% have been recorded, especially in the abdominal fat layer (1). In these studies, the application was generally repeated in half-hour sessions and in 4-5 sessions, as in today's clinical practices.

There are studies showing that radiofrequency application increases tension in soft tissue by creating heat-related shrinkage (contraction) in the structure of the protein called collagen in the connective tissue (2). The shrinkage of collagen occurs clearly at temperatures of 60-80 degrees. These structural changes in collagen have been studied in the cornea of the eye, joints, and cartilage and fatty tissue (1-8). To prevent the technology that causes such heating in the deep tissue from causing burns at the skin level, surface cooling systems have been developed and can keep the temperature at 15 degrees.

Image Note: The devices used in radiofrequency treatment are of different types, including those that do not contact the surface, those that do, and those that sink into the skin, and the electromagnetic field created by each of them is variable.

Radiofrequency therapy is used in aesthetic plastic surgery for skin resurfacing and aged face treatment, varicose vein treatment, acne treatment, treatment of facial pits, treatment of lesions such as rosacea and telangiectasia, and thinning of fat tissue .

Various technologies have been developed for the purpose of radiofrequency treatment, including invasive types that do not touch the skin surface or that come into contact with the skin and even penetrate the skin. These basically aim to make the superficial layers of the skin less affected.

Radiofrequency devices have gained significant popularity in our country in the last 10 years. Technological improvements made in devices over time have enabled the development of cooling systems and increased efficiency. For example, needle radiofrequency systems, which are used more frequently today, provide energy to be delivered directly under the skin with a head consisting of 30-36 microneedles that go in and out of the skin.

Image Note: The head depth and wave frequencies of the needle radiofrequency device are specially adjusted to vary from person to person.

This procedure is painful compared to other systems. Beforehand, regional anesthesia creams are applied and waited for at least 10 minutes.

Redness, which starts during the application, especially needle radiofrequency applications, and then gradually disappears in the first hours, is normal. Itching and burning may also be observed for a short time after application.

Radiofrequency is applied in half-hour sessions, especially when applied for regional slimming purposes. It usually starts with 4 sessions per month. During the control examinations, it is decided whether the sessions will continue or not. Patients can continue their daily lives as they wish.

It should not be forgotten that radiofrequency treatment is not a weight loss method. Our patients should pay attention to their diet and physical activities.

Radiofrequency treatment requires adjusting the frequency and depth of the waves used according to the structural characteristics of the tissue.

Depth and wave frequency adjustments made according to the area to be applied in radiofrequency treatment vary from person to person and from region to region. That's why I always make an evaluation based on skin quality and thickness before application. Unfortunately, in our country, as in the Far Eastern countries, serious burns and scars that are difficult to correct may occur due to practices performed by unqualified hands, which are called "under the stairs". Therefore, make sure that the person performing the application is a plastic surgeon or dermatologist (9).

Radiofrequency therapy works with the heat effect provided by the electromagnetic field, and its application may be unsafe for some people.

As with every application, there are patient groups where radiofrequency should not be applied or should be applied with caution:

Pregnancy and lactation
Patients with metal prosthesis
People with pacemakers (pace-makers)
Those using an intrauterine device (IUD) type birth control method (application should not be performed on the abdomen).
Epilepsy patients
Those with cancer
Patients with bleeding coagulation disorders
Patients suffering from a disease that causes fever.
Patients with inflammatory diseases
heart patients
Liver and kidney patients
Those with hypertension and other circulatory diseases
Those with deep vein thrombosis (those with clotting problems in deep veins)
Presence of infection in the body
Those using treatments such as blood thinners and cortisone
Those with autoimmune diseases
Those suffering from urinary incontinence
Those with infectious diseases
Those who are in menstrual period (abdominal applications should not be performed)
Those with infectious diseases
those under 18

Resources:

Weiss R, Weiss M, Beasley K, et al. : Operator independent focused high frequency ISM band for fat reduction: porcine model. Lasers Surg Med. 2013;45(4):235–9. 10.1002/lsm.22134
Paul M, Blugerman G, Kreindel M, Mulholland RS. Three-dimensional radiofrequency tissue tightening: A proposed mechanism and applications for body contouring. Aesthetic Plast Surg. 2011;35(1):87–95.PubMed PMID: 20835826. Pubmed Central PMCID: 3036829.
Asbell PA, Maloney RK, Davidorf J, Hersh P, McDonald M, Manche E. Conductive keratoplasty for the correction of hyperopia. Trans Am Ophthalmol Soc. 2001;99:79–87.
Obrzut SL, Hecht P, Hayashi K, Fanton GS, Thabit G, III, Markel MD. The effect of radiofrequency on the length and temperature properties of the glenohumeral joint capsule. arthroscopy 1998;14(4):395–400.
Lu Y, Edwards RB, 3rd, Cole BJ, Markel MD. Thermal chondroplasty with radiofrequency energy, an in vitro comparison of bipolar and monopolar radiofrequency devices. Am J Sports Med. 2001;29(1):42–49.
Lu Y, Edwards RB, 3rd, Kalscheur VL, Nho S, Cole BJ, Markel MD. Effect of bipolar radiofrequency energy on human articular cartilage: comparison of confocal laser microscopy and light microscopy. arthroscopy 2001;17(2):117–123.
Teruya TH, Ballard JL. New approaches for the treatment of varicose veins. Surg Clin North Am. 2004;84:1397–1417.
Doshi SN, Alster TS. Combination radiofrequency and diode laser for treatment of facial rhytides and skin laxity. Cosmet Laser Ther. 2005;7:11–15.
Paasch U, Bodendorf MO, Grunewald S, Simon JC. Skin rejuvenation by radiofrequency therapy: methods, effects and risks. J Dtsch Dermatol Ges. 2009 Mar;7(3):196-203. doi: 10.1111/j.1610-0387.2008.06780.x.

Laser and Radiofrequency Treatments