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Introduction

 

Laser toning refers to a treatment using rapid irradiation of laser at low energy, larger spot size, high frequency for the purpose of improving the skin tone. Althoughlaser toning is one of the most important and widely performed procedures in aesthetic dermatology, it is very difficult to use correct device, parameters and techniques for each treatment. In this new series, Dr. Geun-hong Lee of Hong Dermatology, who serves as the Insurance Counsel to theKorean Society for Clinical Therapeutic Dermatology,reveals the safest and most effective techniques of laser toning for each laser device.

 

Previousduallaser toning has clear limitations

This is why treatments that simultaneously tackle pigments, pores and elasticity have been extensively developed. Duallaser toning is such a treatment. Duallaser toninguses simultaneous irradiation of nanosecond Q-switched Nd:YAGlaser and millisecond laser to remove pigments to maximize the benefits of both lasers. This promotescollagenesis by stimulating the dermis. It is a relatively simple procedure that causes little pain and downtime, which is the reason for its long-lasting popularity.

 

However, as the selective photothermolysis theory is starting to fall out of favor, the notion that we can destroy chromophores by irradiating laser in duration shorter than the TRT is no longer recognized. Extended theory of photothermolysiswhich is based on the TDT(thermal damage time) is also losing ground due to reports of side effects of long-pulsed laser such as IPL.

 

To put it bluntly, Asian aesthetic clinicians have been basing their pigment removal treatments on wrong theoretical background. Laser toning uses1064nm Q-switched Nd:YAGlaser at larger spot size, high frequency for the purpose of removing pigments and clarifying the skin tone. However,the more you study the science of laser, you realize the irony of chromphores having higher light absorption with shorter wavelength.

 

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That is, using the 1064nm wavelength in pigment removal is like using an ax to cut your steak. However, most doctors routinely use this wavelength in laser toning without much deliberation. Atthe 532nm wavelength, one can achieve much more successful pigment removal. However, most believe laser toning should be carried out at 1064nm. This is probably because wider wavelengths are safer and 1064nm is regarded as the gold standard for laser toning throughout Asia. As the risk of side effects rise towardFitzpatrick skin types to 3 and 4, wavelength of 1064nm with deeper delivery in the skin causes fewer side effects. One should also consider that treatment success depends heavily on the doctor’s experience level and repeated treatments over long-term.

 

Therefore, the less effective choice of 1064nm Q-switched Nd:YAGlaser is used in laser toning despite inferior efficacy. Continued laser toning leads to pore tightening and rejuvenation from photostimulation of the skin surface rather than direct pigment removal. These secondary effects do contribute to the appearance of clearer skin.

 

-To be continued