What Is Laser Treatment? (video)

E. Victor Ross, MD, director of the Scripps Clinic Laser and Cosmetic Dermatology Center, discusses the benefits and potential side effects of cosmetic laser treatment of the skin, which can be used to remove everything from birthmarks and sunspots to acne scars and wrinkles. Dr. Ross explains how cosmetic laser dermatology today is safer and more effective.

So when we treat patients with lasers in dermatology, we're typically using different types of mechanisms. But overall what we're doing is we're targeting very specific structures in a scan and it's that selectivity that allows us just to treat the bad guy and leave the good guy unscathed.

So, for example, if you had a blood vessel on your nose or a brown spot on your cheek, the lasers we use for the most part are very selective. They only target that brown spot or that blood vessel. And so the normal skin is unfettered. It's undamaged.

So it really is like a smart bomb and that's really the beauty of most of the lasers that we have, the selectivity. They oftentimes rely on color contrast. Red and dark things get hot and light things stay cool. So that's how most of our lasers work. It allows for a lot less pain, a lot more control and faster healing. 

When we talk about lasers in dermatology and the number of things we treat, it's hundreds of things that we can treat. But to break it down into common things, we oftentimes treat either red lesions, which could be port wine stains, which are birthmarks that are red.

We treat, for example, a lot of brown spots, and brown spots can be brown birthmarks but more often in San Diego it's an acquired brown spot from the sun. Those are called lentigines. Then we also have a lot of patients who just have bumps and lumps that we can actually just whittle away with a laser.

So there are a lot of things we can do and what we do is we take each patient, look at what they have and try to match the technology to whatever they're going in with.

So the safety of lasers really depends on lots of things. First, it really depends on the person doing it, so you want somebody who has done it a lot. You don't want somebody whose dabbling or using it as a hobby on the weekends. And unfortunately that's common all over the world now.

We have a lot of people who are doing and using lasers in dermatology and other fields in medicine that frankly just don't have the training. They're smart people but they may not have the training. So I think the first thing to look for is safety [and] who's doing it. It's like driving your car, if you're a five-year-old getting in your car, you're going have a hard time driving it down the road.

And the other thing is the devices themselves. Certainly, the devices now in 2018 are much safer than they were, say, in 2008 and beyond. So the lasers are becoming intrinsically safer but it's the operator and it's the type of laser and oftentimes it's also what you're treating. 

Some things are just safer to do than other things. So that often times is a decision we make when we see the patient. And we talk about that because I think every patient has to consider the risk and the benefits and that equation's very important in making the decision about whether to proceed.

Well, there are side effects with any medical procedure and likewise in laser dermatology certainly there are side effects. And again, it largely depends on what you're doing.

Some procedures are very, very safe. For example, if I was just treating a broken blood vessel in the nose or a brown spot on the face with certain lasers it's very, very safe. There's built-in safety based on the selectivity of the device for that lesion.

Some things are a little bit more dangerous. If we're doing, for example, neck tightening by putting a hot sort of cannula under the skin and heating the skin from inside out. That provides for a little bit less safety margin and you have to be more careful. 

So I think the big complications are related to the more aggressive, invasive procedures. And there are complications. They can range from infection to scarring, to pigmentation. So like any procedure or any list of procedures, there are going to be potential complications. We try to manage those by providing a service that's limited to what we do well. So we like to do a few things well instead of a lot of things not so well.