Dr. David Smart explains how, in the hands of trained professionals, lasers can normalize your skin and treat a multitude of conditions.">

Apr 5, 2016 — Too much hair? Too little hair? Brown spots? Light spots? Wrinkles and fine lines? Dermatological laser therapy might be an answer to your skin problems. Your skin protects you from the environment, but over time the sun, wind and even pollution can damage it. Dermatologist Dr. David Smart explains how, in the hands of trained professionals, lasers can normalize your skin and treat a multitude of conditions.

Interview

Interviewer: What types of skin conditions can laser skin therapy treat? How does it work, and why you should have a dermatologist do the procedure? That's next on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Your skin protects you, and just like any other protective cover it takes damage from the sun, the wind, even pollution. The result a lot of times is fine lines, wrinkles, pigment problems on the face, acne scars, sun damage, the stuff you look in the mirror, you see, and you're like, "I wish that could go away." Well, you don't have to live with all those things. Dermatologists can use lasers to take up to five years off the skin by treating surface issues.

We're with Dr. David Smart. He's a dermatologist with University of Utah Health Care. I want to learn more about your lasers and this skin therapy. So what are some of the common conditions that lasers can treat?

Dr. Smart: Well, that's a great question. I think people don't quite realize, there are many different types of lasers, and different types of lasers treat many different skin conditions. I like to describe lasers as being a modality or a treatment to help normalize the skin. Meaning, when you have too much hair, lasers can remove it. When you have too little hair, lasers can help grow it back. If you have too many brown spots, lasers can help get rid of those brown spots. If you don't have enough, if you have some light spots, lasers can help bring back that color.

So there are a variety of lasers that go after many different targets, and in the end they really help normalize or bring that skin back to health.

Interviewer: That's pretty amazing. How long has this technology been around?

Dr. Smart: It is quite recent in the grand scheme of medicine. In the last 20 or 30 years, there have been many really impressive, remarkable breakthroughs in laser medicine.

Interviewer: So is it fair to say that if you have some sort of a skin issue that bothers you and you're thinking to yourself, "Oh, I wish I could do something about that," lasers might be able to offer a solution?

Dr. Smart: There's a solution for that. It's certainly a possibility.

Interviewer: All right. Get a little geeky for me here. Tell me how does a laser . . . What's going on? Like when the laser hits my skin, how is it fixing problems?

Dr. Smart: Light. When we're dealing with the spectrum of light, not all light is the same. You've got a wide spectrum of light, and that light comes in different sizes. The sunlight is a specific size, and then you get into visible light, blue light, all the colors that you see, that's a different size. You get into ultraviolet, infrared. So there is a spectrum of light.

On that spectrum of light, there are certain things that absorb different wavelengths of light with different sort of affinities, meaning, this brown spot, that's going to absorb this wavelength of light. But really, that other one is not going to even touch it. Fat cells absorb different wavelengths of light, color-making cells. Tattoo pigment absorbs different wavelengths of light.

So what's happening is, depending on the medical condition that you have, someone who knows about laser medicine is choosing a specific wavelength of light, a specific type of laser to treat your condition, because your condition responds to a specific band of light.

When that band of light hits that target, the light is absorbed preferentially by that target and not by the surrounding tissue so that that target can be effectively heat-damaged without damaging everything around it.

Interviewer: When you say "that target," this is a cellular level?

Dr. Smart: Yeah. We're talking real small. We're talking particles. Like the molecule that makes brown in your skin, that's a possible target. The molecule that makes red in your blood vessels, that's a target.

Interviewer: So let's just take the molecule that makes brown. The laser hits it, then what happens to that?

Dr. Smart: The laser hits it, and depending on what setting you've chosen on the laser, you're either warming it up or you're shaking it to the point of disruption or explosion, essentially.

Interviewer: If you want to get rid of it, I would imagine you explode it.

Dr. Smart: Explode it, exactly.

Interviewer: If you want to make it more pronounced, you would warm it up.

Dr. Smart: Yeah, precisely. You would warm it up slowly, and that decreases the inflammatory pathway around it. That can result in improvement in conditions like psoriasis, vitiligo which is a color problem, and even that's why hair loss seems to be helped with certain types of lasers.

Interviewer: What about wrinkles? How are you getting rid of those wrinkles?

Dr. Smart: That's a great question, and while we're geeking out about this the target that you use to get rid of wrinkles is actually water. So you deliver the laser energy at a very specific depth. So you're telling the laser how deep you want to go, and you're essentially exploding, or removing, or damaging all cells that have water, which is all cells, in them in a specific pattern at a specific depth. So when you've calculated that out, you are effectively controlling which skin you're removing and which skin you're leaving.

Like aerating a lawn, the tool that you use is you really just cut it out. With the laser, the laser uses a wavelength that targets water and removes everything with water in that area so that the skin underneath can say, "Yeah. We are looking a little bit old. We are starting to get a little bit thin. We should rejuvenate this area," and the skin really does the rest. It's pretty remarkable that you cause the damage, the skin is what heals and cures itself.

Interviewer: Oh, so you're intentionally damaging skin in order to motivate it.

Dr. Smart: Force it to say, "Hey, step up to the plate here. Start working," and it does.

Interviewer: Very cool. Tell me a little bit about using these lasers, because I think I've heard ads for a lot of organizations that might use lasers for skin treatment. You're a doctor, a physician, a dermatologist, this is your area of expertise. Do you receive some special training, or is there an advantage to coming to you to use this technology?

Dr. Smart: Oh, you bet. So lasers were invented by dermatologists. Back on the East Coast, sort of the grandfathers of laser medicine are dermatologists out of Harvard, and they in fact own many of the companies back there that have created these layers to treat a variety of skin conditions. So there is specialty training both in residency, and there is specialty training in post-residency.

For me, myself, I completed a laser and cosmetic fellowship, extra training after residency for over a year in Manhattan, and those kinds of things do exist. But they're just getting started, and mostly just in dermatology.

Some very important issues, lasers are fairly powerful. Every now and again, more regularly than I'd like to see, a lot of people come in with complications that they've received at medi-spas, or somebody that decided they wanted to stop being whatever their profession was and start treating skin problems and call themselves a laser center.

So you do have to watch out for that, because there is specialty training and not every laser is created the same. Some lasers are Ferraris and some lasers are the Kia Souls, the very cheap type of lasers.

There are more side effects for the lasers that claim to do absolutely everything. And for people who are running them that really don't know the difference in how the chest skin is different from the face, and how the face skin is different from the scalp, what laser settings need to be used to treat those areas, and sometimes to the patient's detriment.

Interviewer: I think the important thing to remember is you've got the technology, and then you need to have the skilled technician that understands how the technology works, how the skin works, how the body is different.

Dr. Smart: Yeah, definitely.

Interviewer: Are the treatments for the various skin conditions relatively the same, in so far as how many treatments you're going to need, how often you need to go in, how long it's going to take? Or does it vary quite a bit?

Dr. Smart: It varies quite a bit. I'll use one specific example, and that's laser resurfacing. Laser resurfacing does a great job at, those lasers that you mentioned before, taking five years off the skin, those are resurfacing lasers.

Interviewer: How do you take five years off the skin? What exactly is going on there?

Dr. Smart: So like you said, skin takes a lot of the brunt of the damage, pollution, time, weather, sun, all of that, and it starts to get blotchy overtime. The pores start to get larger. The texture is not as smooth. It's more cobblestone-y, "crepe-y" we like to call it, a sort of fine paper type of appearance with a lot of wrinkles. Removing those things, normalizing the color, taking away the brown spots and the red spots, making it a smooth tone, and also smoothening out the texture, that's taking at least five years in many cases off the skin.

Interviewer: It sounds like to do something like that, you're probably using a lot of different lasers. Like you've kind of got to mix and match for each patient that comes in, "What are the issues we're trying to solve?"

Dr. Smart: Certainly.

Interviewer: And put together a treatment regimen.

Dr. Smart: Yeah. It's very, very personalized, which brings me back to that point before that not one laser is going to do all of these things. Some of the lasers actually do take quite a bit of time, a course of them. You are going to want to repeat some of these lasers four to six times. Some of the other lasers that have a little bit more bang right up front as far as their efficacy, they also have more downtime. So there are some lasers that are going to get you five years off the skin with just one treatment, but you're probably going to not want to leave the house for a week.

You're going to be a little bit red. It's going to be apparent that you had something done for several weeks after that treatment. Whereas, some of the other lasers that do the same thing in a more conservative, more elegant fashion, they get you the same result, but it might take six months, nine months of repeating this laser treatment on a regular basis. But your downtime, much better.

Interviewer: There again, that's where having somebody that really understands the skin and how these lasers work, and the best laser for the job. Are there side effects to these treatments? Twenty, 25 years down the road, am I going to have less skin now and I'm going to be more vulnerable to the elements?

Dr. Smart: That's a great question. Surprisingly, no. To be totally fair, we haven't been doing these treatments on a very large scale for more than a few decades. So we don't have quite that much evidence. But going back to what I said, normalizing the skin, so the skin actually becomes healthier, stronger, and thicker with repeated laser treatments, rather than thinner and less skin.

Interviewer: This is such a crude analogy. It's not like sandblasting?

Dr. Smart: No, it's not like sandblasting.

Interviewer: It actually makes the skin healthier. That's fascinating.

Dr. Smart: Yeah. It's more like aerating a lawn, actually. You're removing certain places, but leaving healthy patches to grow in, fill in that area.

Interviewer: Then, overtime it becomes a healthier lawn.

Dr. Smart: It's even healthier, yeah.

Interviewer: The skin becomes healthier with laser treatment as well.

Dr. Smart: Precisely.

Interviewer: Are there any side effects? You had mentioned that some treatments you might need to take a few days off, because somebody would be able to tell that something happened.

Dr. Smart: Oh, yeah. Most definitely, and of course depending on the laser entirely. But laser energy is essentially, when it all boils down to it, heat. So burns are the most common side effect, burning, blistering, and most of the time you're trying to get a mild burn. You're going for a light sunburn appearance, because that's what the result is to show efficacy.

You really do want to have some appearance that something's been done. Generally speaking, that can go away in anywhere from 30 minutes to a day, a few days, and that just depends on the laser you choose and what you're going after.

Interviewer: What should a listener know to make an informed decision about this? I think we've covered a lot of the bases. Is there anything that I forgot?

Dr. Smart: There are many different lasers, and there are many different problems, tattoos, scars, and a variety of medical treatments that can effectively be treated by laser. So you really just have to go somewhere that has some experience.

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