To date, the methods of laser irradiation applied to the skin is much more frequent than in any other tissues, due to an exceptional variety and prevalence of skin diseases and a variety of cosmetic defects, as well as the relative simplicity of the procedures, which is associated with a surface location of objects requiring lecheniya.Lazernoe rejuvenation can be attributed to the most efficient and versatile methods of struggle with involutional changes in the skin. Target chromophores for laser radiation are almost all the chemical structures of the skin - the water, hemoglobin, melanin, collagen. The selectivity of the laser action allows you to choose individual scheme correction of involutional disorders of the skin in any type of aging skin. Wide demand for laser treatments, their high efficiency dictate the need to synthesize the available current data on the benefits and features of the application, as well as to the tactics of patients that can benefit greatly assist the individual laser medicine in the choice of the most efficient technology with the correct ratio of efficacy and safety. In this review article provides current data on the method of laser skin resurfacing using a CO2 laser with a description of the phase of patient management. Describes in detail the predicted side effects, adverse events, and methods for their prevention and correction.
laser, laser photothermolysis, ablation
Методы лазерного воздействия применяются для манипуляций на коже намного чаще, чем на любых других тканях. Это объясняется двумя моментами. Во-первых, исключительным разнообразием и распространенностью кожной патологии и различных косметических дефектов, а во-вторых, относительной простотой выполнения процедур, что связано с поверхностным расположением объектов, требующих лечения.
Слово лазер – это побуквенный перевод англоязычного термина laser, сформированного из аббревиатуры от слов Light Amplification by Stimulated Emission of Radiation – усиление света посредством стимулированной эмиссии излучения.
Лазеры, используемые в медицине, генерируют излучение в видимой (λ – 380-760 нм), инфракрасной (λ>760 нм), ультрафиолетовой (λ<380 нм) и рентгеновской (λ<1 нм) областях спектра электромагнитных волн.
Основой работы лазера является его активная среда. Материалом для нее могут быть твердые тела (кристаллы, сплавы, полупроводники), жидкости (растворы красителей) или газы (СО2, галогены, инертные газы или газовые смеси). От состава активной среды зависит длина волны и некоторые другие параметры излучения, испускаемого данным лазером. Активация среды достигается с помощью электромагнитных волн или мощного светового потока, в результате чего происходит возбуждение большинства молекул и атомов до возбужденного (excited) состояния. Спонтанное возвращение к исходному состоянию единичных молекул и атомов среды сопровождается выходом из каждого из них светового кванта (фотона электромагнитного излучения). Соударение такого фотона с другой возбужденной мишенью ведет к выходу из нее своего фотона (стимулированный фотон – stimulated), а он в свою очередь даст начало следующему и т.д. таким
1. Nevorotin AI. Vvedenie v lazernuyu khirurgiyu: Ucheb. posobie. Spb.: SpetsLit; 2000. Russian.
2. Nevorotin AI. Lazernaya rana v teoreticheskom i prikladnom aspektakh. Lazernaya biologiya i la-zernaya meditsina: praktika. Mat. dokl. resp. shkoly-seminara. Chast´ 2. Tartu – Pyukhyayarve: Izd-vo Tartusko-go universiteta ESSR; 1991. Russian.Goldman L, Blaney DJ, Kindel DJ, et al. Effect of the laser beam on the skin: preliminary report. J Invest Dermatol 1963; 40: 121 – 122.
3. Anderson RR, Parish JA. The optics of human skin. J Invest Dermatol.1981;77:13-9.
4. Altshuler GB, Anderson RR, Manstein D, et al. Extended theory of selective photothermolysis. Lasers in Surgery and Medicine. 2001;29:416-32.
5. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524-7.
6. Margolis RJ, Dover JS, Polla LL, et al. Visible action spectrum for melanin-specific selective photothermolysis. Lasers Surg Med. 1989;9:389-97.
7. Michael S Kaminer, Kenneth A Arndt, Jeffrey S Dover et al. Atlas of cosmetic surgery. Second edition. Saunders Elsevier; 2009.
8. Alster TS. Manual of cutaneous laser techniques. Philadelphia, Pa; Lippincott, Williams & Wilkins; 2000.
9. Khatri KA, Ross V, Grevelink JM, et al. Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. Arch Dermatol. 1999;135:391-7.
10. Markolf H. Niemz. Laser-Tissue Interactions. Springer-Verlag; 1996
11. Ashley J. Welch and Martin J. C. van Gemert. Optical-Thermal Response of LaserIrradiated Tissue. Plenum Press; 1995.
12. Crochet JJ, Gnyawali SC, Lemley YCEC, Wang LV, Chen WR. Temperature distribution in selective laser-tissue interaction. Journal of Biomedical Optics. 2006;11(3).
13. David J. Goldberg. Laser and lights; 2005.
14. Gereon Huttmann, Cuiping Yao, and Elmar Endl. New Concepts in Laser Medicine:Towards A Laser Surgery With Cellular Precision. Medical Laser Application. 2005;20(2):135-9.
15. Vincent KM Poon, Lin Huang, and Andrew Burd. Biostimulation of dermal fibroblast by sublethal Q-switched Nd:YAG 532 nm laser: collagen remodeling and pigmentation. Journal of Photochemistry and Photobiology B. Biology. 2005;81(1).
16. Derek A. Affonce and Alex J. Fowler. The effect of thermal lensing during selective photothermolysis. Journal of Quantitative Spectroscopy and Radiative Transfer. 2002;73(2-5):473-9.
17. Bernstein EF. Laser treatment of tattoos. Clinics in Dermatology.2006;24(1).
18. Leandri M, Saturno M, Spodavecchia L, Iannetti GD, Crucco G, Truni A. Measurements of skin temperature after infrared laser stimulation. Clinical Neurophysiology. 2005;36(4):207-18.
19. Verkryusse W, Jia W, Franco W, Milner TE, Nelson JS. Infrared Measurement of Human Skin Temperature to Predict the Individual Maximum Safe Radiant Exposure (IMSRE). Lasers in Surgery and Medicine. 2007;39:757-66.
20. Orazio Svelto, David C. Hanna. Principles of Lasers. Springer, 4th edition; 1998.
21. Lihong Wang, Steven L. Jacques. Monte Carlo Modeling of Light Transport in Multi-layered Tissues in Standard C; 1998.
22. Ross EV, Ladin Z, Kreindel M, et al. Theoretical considerations in laser hair removal. Dermatol Clin. 1999;17:333-55.
23. King TA. In Lasers and Current Optical Techniques in Biology, G. Palumbo and R Pratesi (Eds.) (RSC, London, 2004) Chapter 2.
24. Clement RM, Kiernan MN, Donne K. Treatment of vascular lessions, US Patent 6398801 (2002).
25. Alena R.A.P. Medrado BS1, Lívia S. Pugliese BS2, Sílvia Regina A. Reis PhD2, Zilton A. Andrade MD1 Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers in Surgery and Medicine. 2003;32(3):239-44.
26. Sung Bin Cho MD1, Jin Young Jung MD1, Dong Jin Ryu MD1, Sang Ju Lee MD, PhD2, Ju Hee Lee MD, PhD1, Effects of ablative 10,600-nm carbon dioxide fractional laser therapy on suppurative diseases of the skin: A case series of 12 patients. Lasers in Surgery and Medicine. 2009;41(8):550-4.
27. Tsutomu Fujimura1, Yoshinori Takema PhD1, Shigeru Moriwaki1, Kazue Tsukahara1, Genji Imokawa PhD1, Akira Yamada MD2, Syuhei Imayama MD. Analytical method to examine the effects of carbon dioxide lasers on skin: A study using wrinkles induced in hairless mice. Lasers in Surgery and Medicine.2001;28(4):348-54.
28. Shun Lee PhD1, Daniel J. McAuliffe MS1, Thomas J. Flotte MD1, Nikiforos Kollias PhD2, Apostolos G. Doukas PhD1. Photomechanical transdermal delivery: The effect of laser confinement. Lasers in Surgery and Medicine.2001;28(4):344-7.
29. Jenifer R. Lloyd DO1, Mirko Mirkov PhD Selective photothermolysis of the sebaceous glands for acne treatment. Lasers in Surgery and Medicine.2002.31(2):115-20.
30. Dan Zhu PhD, Qingming Luo PhD1, Guangming Zhu PhD, Wei Liu. Kinetic thermal response and damage in laser coagulation of tissue. Lasers in Surgery and Medicine. 2002;31(5):313-21.
31. Steven Dayan MD1, John F. Damrose MD, Tapan K. Bhattacharyya PhD, Steven Ross Mobley MD, Minu K. Patel MS, Kevin O´Grady BS, Steven Mandrea MD. Histological evaluations following 1,064-nm Nd:YAG laser resurfacing. Lasers in Surgery and Medicine.2003;33(2):126-31.
32. Simone Laube MD, MRCP, Saleem Taibjee MRCPCH, Sean W. Lanigan MD, FRCP, DCH Treatment of resistant port wine stains with the V Beam® pulsed dye laser. Lasers in Surgery and Medicine. 2003;33(5):282-7.
33. Sol Kimel PhD, Lars O. Svaasand PhD, Marie J. Hammer-Wilson MS1, J. Stuart Nelson MD, PhD. Influence of wavelength on response to laser photothermolysis of blood vessels: Implications for port wine stain laser therapy. Lasers in Surgery and Medicine. 2003;33(5):288-95.
34. Lene Hedelund MD1, Merete Haedersdal PhD, DMS, Henrik Egekvist PhD, Michael Heidenheim MD, Hans Christian Wulf DMS, Thomas Poulsen MD. CO2 laser resurfacing and photocarcinogenesis: An experimental study. Lasers in Surgery and Medicine. 2004;35(1):58-61.
35. D.J. McGill MRCS(Ed), C. Hutchison MA, E. McKenzie BSc, E. McSherry RGN, I.R. Mackay FRCS(Plast). A randomised, split-face comparison of facial hair removal with the alexandrite laser and intense pulsed light system. Lasers in Surgery and Medicine.2007;39(10):767-72.
36. Gitte F. Jørgensen MD, Lene Hedelund MD, PhD, Merete Hædersdal M, MD, DMedSci, PhD. Long-pulsed dye laser versus intense pulsed light for photodamaged skin: A randomized split-face trial with blinded response evaluation. Lasers in Surgery and Medicine.2008;40(5):293-9.
37. Jihoon Kim PhD, Raheel John MS, Paul J. Wu PhD, Mary C. Martini MD, Joseph T. Walsh Jr. PhD. In vivo characterization of human pigmented lesions by degree of linear polarization image maps using incident linearly polarized light. Lasers in Surgery and Medicine.2010;42(1):76-85.
38. Syrus Karsai MD, Agnieszka Czarnecka MD, Michael Jünger MD, PhD, Christian Raulin MD, PhD. Ablative fractional lasers (CO2 and Er:YAG): A randomized controlled double-blind split-face trial of the treatment of peri-orbital rhytides. Lasers in Surgery and Medicine.2010;42(2):160-7.
