Laser surgery in dermatocosmetology

Laser surgery is currently becoming more widespread due to the convenience of using high-temperature exposure for cutting or evaporating tissue and the high coagulating properties of laser radiation. These factors make the laser destruction procedure well-controlled and comfortable for both the doctor and the patient.

The thermal effect of laser radiation in biological tissue is based on the absorption of radiation and the conversion of its energy into heat. The absorption coefficient depends on the type of tissue and the wavelength of the laser radiation. The amount of absorbed radiation decreases with depth, so the thermal energy and temperature decrease in the depth of the tissue. Heat is removed due to thermal conductivity and blood flow. Thus, a temperature gradient occurs both in depth and in the perpendicular direction. The optical and thermal properties of a particular tissue play a decisive role in achieving a certain temperature using laser radiation. The most suitable wavelengths for influencing skin tissue are from 840 to 1060 nm. It is the waves of this range that are effectively absorbed by water molecules and the pigment melanin, heating the skin tissue to very high temperatures and causing their evaporation. Currently, the optimal carriers that allow receiving laser radiation of these waves are semiconductors. They are lightweight, reliable, relatively cheap, compact, which allows for the production of compact and reliable surgical diode laser devices. A big advantage of diode lasers is the ability to operate in a continuous mode, which, compared to pulsed, allows for a more dosed and accurate effect on tissues. In addition, semiconductor laser devices are equipped with convenient flexible light guides that deliver radiation directly to the desired point and allow for work in contact mode. Work in contact mode ensures high accuracy of laser destruction.

The incision and coagulation with a laser are performed without tissue destruction, unlike low-frequency electrosurgical cauterizers, when using which tissue damage can be comparable to a third-degree burn. When exposed to powerful laser radiation, a temperature approaching 1000 C develops in the tissues, which allows for tissue evaporation in a very short period of time, during which the surrounding tissues do not have time to undergo thermal changes. Since there is no pronounced trauma to the surrounding tissues and bleeding, it is easier for the doctor to visually control the volume of laser destruction, which is extremely important when removing a skin neoplasm. A narrow zone of thermal damage to the surrounding tissues allows in most cases to keep the removed material suitable for morphological examination. Healing occurs without pain and the formation of coarse cicatricial changes. In addition, laser radiation also has a sterilizing effect, which means that the risk of complications is significantly reduced.

There is no need for additional treatment of the wound surface with preparations to improve reparation (healing), since healing occurs under the fibrin film formed on the wound surface, and laser radiation and radio waves have a sterilizing and disinfecting effect. The fibrin film is rejected on the 1-8th day, which is accompanied by minor serous discharge. Bleeding, which occurs in 15-30% of cases when the scab is rejected after electrosurgical excision, is not observed.

Laser surgery significantly simplifies, improves and accelerates surgical procedures. The advantages of laser technology include such features as speed of treatment, almost complete absence of blood during surgery, minimal postoperative pain and accelerated healing. No anesthesia is required for laser surgery, i.e. local anesthesia is almost always sufficient. After laser surgical manipulations, there are practically no unpleasant postoperative consequences such as pain, swelling, infections, postoperative shock from blood loss.

Cosmetic results of laser destruction are much higher than those of other surgical methods - traditional surgery, electrosurgery (electro- and diathermocoagulation), cryodestruction (exposure to low temperatures). Cosmetic results of laser surgery depend on the correct selection of laser radiation parameters.

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