Application of ultra-pulsed carbon dioxide laser in medical cosmetology
Feng Haitao (Huarong Plastic and Cosmetic Agency, Nanchang 330006)
The laser was born in 1950 and was used in the medical field the following year. With the development of laser technology, the earlier continuous carbon dioxide laser has achieved remarkable results in medical cosmetology, but due to the thermal damage it produces, it is difficult to use. There are restrictions. According to the principle of selective photothermolysis (Selective photothermolysis) proposed by Aderson and Parrish, the application of pulsed laser system is possible. Ultra-pulse carbon dioxide laser has a pulse width of milliseconds or even nanoseconds, and the output power is very high, some of which can reach 500 watts, which can instantly vaporize and cut off tissues without carbonization. Eschar. Its function is precise, the tissue thermal damage is small, and the safety is high, and it is widely used in medical cosmetology. It has made a breakthrough in the treatment of medical beauty, and it has become the latest medical beauty surgical instrument.

1. Blepharoplasty
Blepharoplasty is a common procedure in cosmetic surgery. The skin of the eyelid is thin, delicate in texture, rich in tissue blood supply, active in expression muscles, and high in nerve sensitivity: traditional blepharoplasty has more bleeding, obvious postoperative swelling, and a long recovery period. Replacing the scalpel with ultra-pulsed carbon dioxide laser has obvious advantages. Ultra-pulsed carbon dioxide laser has high photoelectric conversion efficiency and large output power. After focusing, it can become a fine beam with high power density, strong cutting force, sharp incision, and incision. The tissues on both sides are slightly dehydrated and contracted due to photothermal action, the small blood vessels (less than 1 mm in diameter) and lymphatic vessels are closed, and the surgical field is clear. Surgery can be performed. In this way, the incision can be precise and smooth, and the surrounding organs and tissues will not be accidentally injured. There are unique advantages in blepharoplasty, especially through lower eyelid conjunctival bagectomy. The above characteristics can be manifested as (1) little or no bleeding, fast healing and recovery; (2) mild tissue swelling. ③ After healing, the traces are not obvious, and it is natural and beautiful.
In addition to the upper and lower eyelids, the ultra-pulsed carbon dioxide laser is also routinely used in various cosmetic and plastic surgeries such as small tumors, scars, rhinoplasty, buccal fat pad removal, small incision wrinkle removal, and eyebrow shaping, all of which have achieved the above-mentioned good results.
2. Skin resurfacing
Aging mainly results from the destruction of skin tissue structure such as collagen tissue and elastic fibers by excessive ultraviolet radiation. The traditional methods of skin resurfacing and wrinkle removal include grinding wheel (or microcrystalline) dermabrasion and chemical peeling. Although these methods are commonly used in the treatment of sun-damaged skin wrinkles, their common disadvantage is that the depth of treatment is not easy to control, and the efficacy is often unsatisfactory. In addition, grinding wheel microdermabrasion will cause tissue debris and blood splashing, leading to infection and cross-infection. The drugs in chemical peels can cause damage to liver and kidney function after being sucked. In the 1980s and the early 1990s, continuous carbon dioxide laser can be used for skin resurfacing and wrinkle removal. Although it has achieved obvious results, it is also eliminated due to its large thermal damage and high risk of scarring.
In 1994, the American Keiren Laser Company developed a high-energy ultrapulse carbon dioxide laser (Ultrapulse 5000), which can control the time of the thermal effect in the laser pulse to be shorter than the thermal diffusion time in the target tissue, so that the skin damage can be completely eliminated by vaporizing the diseased tissue. Minimal thermal damage to surrounding normal skin, of course energy density is also important when grinding. The critical energy density of human skin laser is 200 watts per square millimeter. If it is lower or higher than this number, it will cause skin anxiety. Also, the width of the wave should be less than one-third of the width of the separation between waves, so that the remaining heat can be dissipated before it is transferred to the surrounding normal tissue.
The operation generally uses a 3 mm spot hand tool, 3-7 watts of energy (about 500 mJ per pulse), and vertical irradiation for 2-5 times. After each grinding, use saline gauze to wipe off the residual skin flakes, which can be clearly seen. The smoothness and depth of the skin after grinding, and the shrinkage of the dermis can be seen. There is generally no bleeding during grinding. For those with sensitive pain, epidermal anesthesia can be used, and oil gauze is used after surgery. The recovery period is about 7 to 10 days, and the skin will become smooth and delicate after surgery. Postoperative histological analysis showed that there was a collagen deposition layer in the superficial part of the dermis of the treatment area, the collagen bundles were dense, and the new elastic fibers on the surface were arranged in parallel and in a straight line. Ultra-pulsed carbon dioxide laser dermabrasion and wrinkle removal has obvious curative effect on wrinkles caused by skin tissue relaxation induced by ultraviolet radiation. Especially around the eyes, followed by the forehead, nose root, cheeks, and around the mouth. Wrinkles caused by muscle movement are like eyebrows. The improvement of the nasolabial fold was not obvious. At present, the Asian population (mostly Fitzpatrick type 3-4) faces the biggest problem in receiving laser dermabrasion and wrinkle removal
It is post-operative hyperpigmentation. In order to prevent hyperpigmentation, suitable patients must be selected according to skin characteristics before surgery. Sun protection is necessary for 2-3 months after surgery. Sunscreen, oral VC, and external rubbing of hydroquinone cream can speed up pigmentation. ·
3. Treatment of skin pigmented sexually transmitted diseases and body surface vegetations
Pigmented diseases are one of the most common causes affecting beauty in cosmetic dermatology. Ultra-pulse carbon dioxide laser evaporates the diseased tissue on the skin surface through instant strong photothermal action. Dehydration, vaporization and disappearance, the increase of venereal pigment on the skin, including exogenous epidermal pigment can be removed. Of course, when the pigment particles are deep to the middle layer of the dermis, it is not necessary to blindly ablate the skin in order to treat the pigment too deep to avoid scarring. At this time, it can be combined with the Q-switched pigment laser therapy device, which can achieve the effect that cannot be achieved by a single device, and can shorten the course of treatment for deep pigmentation by the Q-switched laser.
Ultra-pulsed carbon dioxide laser ablation can be used for surface vegetations, moles, warts, xanthelasma, etc. During the treatment, a wet cotton swab is constantly used to wipe off the residual tissue. The laser energy needs to reach the critical value of skin tissue ablation (about the same as the value of microdermabrasion and wrinkle removal), otherwise too low energy for long-term burning will aggravate tissue damage. After tissue ablation, there is a 0.02 mm wide thermal damage area on the residual surface. Most of the tissue cells can recover after operation, so the postoperative traces are not obvious.
4. Summary
The application of ultra-pulsed carbon dioxide laser in medical cosmetology has made remarkable achievements, it can also be used for hair transplantation, treatment of armpits
Collection of the first exchange meeting on filial piety in dermatology in Jiangxi Mexico
It is also widely used in other clinical disciplines, such as laser-assisted draping, soft palate plastic surgery (LAUP),
Combined with endoscopic cavity surgery, myocardial laser drilling and so on. However, there are also some treatments that are not satisfactory and insufficient, especially skin abrasions.
Pigmentation after ablation and ablation. But with the development of laser medicine and the exploration of medical aesthetic experts, more and better equipment and more
The newer and more perfect technology has brought medical cosmetology to a higher level and met people's needs for beauty.