Laser surgery in dermatocosmetology

Laser surgery is now becoming more widespread due to the ease of using high-temperature effects for the cutting or evaporation of tissue and the high coagulating properties of laser radiation. These factors make the procedure well-controlled and comfortable for both physicians and patients.

The thermal effect of laser radiation in biological tissue is based on absorbing radiation and converting its energy into heat. The absorption coefficient depends on the type of tissue and on 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. The heat is removed due to the thermal conductivity and blood flow. Thus, a temperature gradient appears both in depth and in the perpendicular direction. The optical and thermal properties of a given fabric play a decisive role in achieving a certain temperature with the aid of laser radiation. The most suitable for affecting the tissues of the skin are wavelengths from 840 to 1060 nm. It is the waves of this range that are effectively absorbed by water molecules and melanin pigment, warming the skin tissues to very high temperatures and causing their evaporation. At present, semiconductors are the optimal carriers that make it possible to obtain laser radiation from these waves. They are light, reliable, relatively cheap, compact, which makes it possible to produce compact and reliable surgical diode laser devices. A great advantage of diode lasers is the ability to work in a continuous mode, which, in comparison with the pulsed, allows more dosed and accurately affect the tissues. In addition, semiconductor laser devices are equipped with convenient flexible light guides that deliver radiation directly to the desired point and allow working in contact mode. Work in the contact mode ensures high accuracy of the laser-construction.

The incision and coagulation with the help of the laser are performed without destroying the tissues, in contrast to the electrosurgical low frequency surges (electric cauters), in which the tissue damage can be compared with the third degree burn. When the powerful laser radiation in the tissues develops, the temperature approaches l000 C, which allows evaporation of tissues in a very short period of time, for which the surrounding tissues do not have time to undergo thermal changes. Since there is no pronounced trauma to surrounding tissues and bleeding, it is easier for the physician to perform visual control of the volume of the laser degeneration, which is extremely important in the removal of the neoplasm of the skin. A narrow zone of thermal damage to surrounding tissues allows, in most cases, to keep the removed material suitable for morphological investigation. Healing occurs without pain and the formation of gross 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 drugs to improve repair (healing), since the healing takes place under the fibrin film formed on the wound surface, and laser radiation and radio waves have a sterilizing and detoxifying effect. The fibrin film is rejected on the 1-8th day, which is accompanied by insignificant secretions. Bleeding, which occurs in 15-30% of cases when the scab is rejected after electrosurgical excision, is not observed.

Laser surgery greatly facilitates, improves and speeds up surgical procedures. Advantages of laser technology are such features as the speed of treatment, almost complete absence of blood during surgery, minimal postoperative pain and accelerated healing. To perform surgical intervention with a laser, anesthesia is not needed, i.e., there is almost always enough local anesthesia. After laser surgical manipulations, there are almost no unpleasant postoperative consequences, such as pain, swelling, infection, postoperative shock from blood loss.

The cosmetic results of laser erosion far exceed the results after the application of other surgical methods - traditional surgery, electrosurgery (electro-and diathermocoagulation), cryodestruction (low-temperature effects). Cosmetic results of laser surgery depend on the correct selection of laser radiation parameters.

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