If you suffer from skin conditions such as pigmentation, enlarged pores, oily skin and acne scarring, you will probably know that these are conditions that usually do not improve on their own without treatment. Invariably, laser treatment is the treatment of choice by many doctors for many of these conditions, because laser light, tuned into specific wavelengths, can be focused into beams, resulting in powerful medical treatments.
Laser therapy is actually not new in skin resurfacing and treatment of pigmentation. In fact, lasers were used as early as the 1960s to treat birthmarks. Back then, lasers were much stronger and caused more complications. Today, laser technology has evolved and most lasers now treat various skin problems in a way that minimizes the risk of side effects.
Also, the line up of lasers today is stunning. But the public needs to be educated that there are different lasers to treat different skin problems, and within a specific type of laser, there are many manufacturers, with prices ranging from affordably cheap to expensive. Some of these laser treatments can be very strong and promise new, vibrant skin just after a single session. Others promise the same, with lesser risks. And then there are low or no-downtime treatments, such as laser toning, whose popularity can be attributed to mass market clinic chains found in many neighborhoods today. In these clinics, laser toning is frequently sold in large packages, but with prices starting as little as $30 per session.
Nonetheless, side effects of laser treatments are not uncommon, from a transient flush immediately post treatment, to irreversible scarring. Just how can lasers worsen our skin?
Here, we’ve put together an informative guide about possible side effects of laser treatments, and how to pick your treatments smartly.
Too Dark or Too Light?
While lasers are effective for treatment of pigmentation, they are not free of side effects. One of the risks associated with laser therapy is post inflammatory hyperpigmentation (PIH), where the skin reacts to the trauma of heat by creating or releasing MORE pigment. This means that instead of lightening the pigmentation, it becomes darker.
In darker skin individuals, laser injuries can cause the reverse: skin can become permanently de-pigmented, known as hypopigmentation, because the skin cells responsible for creating pigment are destroyed.
Laser Toning and Guttate Hypopigmentation
Laser toning is frequently used to treat pigmentation problems such as melasma, and offers facial rejuvenation by stimulating collagen. It is sometimes used by doctors to reduce facial oiliness and improve acne, albeit mildly. Laser toning uses a Q-switched Nd-Yag laser, which targets pigment deposits within the skin. Because it takes only less than 5 minutes to administer the treatment, is generally very bearable even without topical numbing, and leaves behind only a hint of redness which goes away on its own after 1-2 hours, it has found its way into the mass market, with some clinics offering it as frequently as once or even twice a day.
Here’s where things can go awry. If one thought a simple, low-risk treatment such as laser toning can be done repetitively at such short intervals, it must be completely safe, one couldn’t be more wrong.
Guttatte hypopigmentation is a phenomenon that doctors are starting to see, several years after the advent of cheap and affordable mass market laser toning treatments. In this condition, white patches of de-pigmented skin gradually appear, resulting in a lacey, mottled appearance.
According to Dr Low Chai Ling, Medical Director of The Sloane Clinic, she has seen at least 3 of these cases in the last 12 months, all of which were most challenging to treat.
“It is most likely a culmination of repetitive, low dose laser treatments, reducing the activity of some melanocytes and resulting in patchy areas of hypopigmentation” says Dr Low, who hopes that the public can be better educated regarding this potential side effect of long-term, overly frequent laser toning treatments.
Do They Get Better?
For guttate hypopigmentation, the prognosis is poor with and Dr Low suggests stopping laser treatments completely once hypopigmented macules appear.
But that is not to say that any form of laser toning is bad.
“Always go for the gold standard when shopping for laser treatments, those which provide consistent results and have a track record for safety, especially in darker skin types”, says Dr Low. She was referring to the pigment lasers MedLite C6 and the new-generation RevLite , the “workhorses” of aesthetic lasers.
“Unfortunately, unlike hyperpigmentation, hypopigmentation is often refractory to treatment, because the machinery for producing normal skin pigment is impaired in the first place”. Laser toning has great results, if done correctly. She further advices that laser toning for melasma should be limited to every 4 weeks, and anything more frequent than once a fortnight should put one on high alert for development of complications.
For those with PIH, the good news is it usually resolves spontaneously although it can take several months to years for the marks to fade away completely. According to Dr Low, lightening creams such as those containing hydroquinone or mequinol can be used, but it only starts to work after several weeks, and one should expect to notice improvements only after several months of use. Light chemical peels such as glycolic acid, and low dose photobiomodulation therapy may also help speed up resolution of these unsightly pigments.
It is important to realise that not all lasers are made the same. Neither do they all give the same side effects. In fact, some gentle fractional resurfacing lasers such as Fraxel can help improve side effects seen above such as mottled pigmentation. Besides the type of laser, tt is also vital to remember that the power of the laser therapy as well as the skill of the practitioner may also play a part in the final outcome. At the end of the day, as long as you choose the right type of laser for your skin condition, you should expect a safe and effective outcome.
“I have been treated by a doctor who tried to over-sell one single laser treatment to me, while putting down his competitors'” recounts Charlene Tan, a 31-year old accounts executive based in Singapore. “He was so glib that for months I believed that all the other laser treatments out there were ‘dangerous’ and ineffective even when his treatment made my melasma worse not better after 5 sessions. But I was too scared to try anything else because he kept telling me about all the awful things that was going to happen to me if I stopped going to him” continues Charlene with a wry grin.
“The thing is you must do your homework. There is no one laser that is good for everything. Be careful of doctors who oversell a laser. Similarly, be careful of doctors who use scaremongering tactics to put you off other lasers,” she says. After several attempts at getting her melasma lightened without success, Charlene finally found success with a series of fractional resurfacing lasers and microdermabrasion as well as a judicious regime of skincare containing mequinol and tranexamic acid at another clinic. “I now only visit clinics which offer a wide variety of different laser therapies, and not one-man shows with only one or two laser offerings.”
“There is enough misinformation out there on the internet. We need to be very careful when reading things to know not to jump to conclusions.”
Just like cars, a Proton would never be considered the same as a Ferrari, so one should not assume different machines are equivalent. More importantly, lasers are inevitably machines, and we all know machines are operator-dependent. While all doctors are medically qualified, I would be putting my faith in the doctor who has intimate knowledge of the lasers he or she operates. Afterall, it only takes one bad treatment to ruin everything.
This reminds me of a quote: “I regret taking such good care of my skin – said no one ever”. Choose your treatments wisely!