The primary mechanism is selective photothermolysis. This sophisticated process involves emitting laser light at specific wavelengths designed to be absorbed exclusively by target molecules, known as chromophores, within the skin. Upon absorption, this light energy is converted into thermal energy, destroying the pathological tissue (such as a vein or sun spot) while preserving the surrounding healthy skin.
The efficacy of medical lasers relies on precise wavelength absorption. By tuning the laser to interact exclusively with specific targets like pigment or blood vessels, practitioners can achieve controlled thermal destruction of the lesion while leaving the surrounding tissue intact.
The Science of Precision: Selective Photothermolysis
Defining the Core Principle
The fundamental physical method behind professional laser systems is selective photothermolysis.
Unlike general cauterization, which burns everything it touches, this principle allows for the discrimination between "target" and "background."
The laser ignores healthy skin structures and seeks out specific targets based on their color and light absorption properties.
Targeting Chromophores
To work effectively, the laser beam must find a chromophore—a molecule responsible for color that absorbs specific light wavelengths.
The two primary chromophores targeted in aesthetic treatments are melanin (for pigment) and oxyhemoglobin (for blood vessels).
By matching the laser's wavelength to the absorption peak of the chromophore, the system ensures energy is delivered only where it is needed.
From Light to Thermal Destruction
Once the chromophore absorbs the laser light, a physical conversion occurs.
The light energy transforms rapidly into thermal energy (heat) within the target structure.
This intense, localized heat destroys the pathological tissue—whether it is breaking up a cluster of melanin or collapsing a dilated blood vessel.
Applications in Treating Lesions
Treating Pigmented Lesions
For brown spots, age spots, or melasma, the laser targets the excess melanin.
Technologies like Q-switched lasers deliver energy that breaks up the pigment in benign lesions, often clearing them in one to two treatments.
This process removes the discoloration layer by layer, revealing the unblemished skin beneath without damaging the surface texture.
Treating Vascular Lesions
When treating spider veins or redness, the target changes from melanin to oxyhemoglobin found in red blood cells.
The laser heat coagulates the blood and damages the vessel wall.
This causes the vessel to collapse and eventually be reabsorbed by the body, effectively removing the vascular lesion.
Understanding the Trade-offs
Specificity vs. Versatility
Because lasers rely on specific wavelengths, they are rarely "all-in-one" solutions.
A wavelength optimized for absorbing red oxyhemoglobin may pass right through brown melanin, rendering it ineffective for pigmentation.
Practitioners must understand that high specificity means you need the right tool for the specific chromophore.
Balancing Power and Safety
The goal is to deliver enough heat to destroy the target without allowing that heat to diffuse into surrounding tissue.
If the energy delivery is too slow or the cooling is insufficient, the "selective" nature of the treatment fails.
This can result in thermal damage to healthy skin rather than just the lesion.
Making the Right Choice for Your Goal
To select the appropriate setting or device, you must identify the primary chromophore you intend to target.
- If your primary focus is Vascular Lesions: Ensure your system emits a wavelength with high absorption in oxyhemoglobin to effectively coagulate blood vessels.
- If your primary focus is Pigmented Lesions: Prioritize systems like Q-switched lasers that target melanin, capable of shattering pigment in age spots or sun damage.
- If your primary focus is General Rejuvenation: Consider that broad-spectrum devices like IPL target both chromophores simultaneously but with less specificity than dedicated lasers.
True clinical success comes from matching the laser's wavelength to the biology of the blemish.
Summary Table:
| Feature | Targeted Chromophore | Primary Effect | Common Applications |
|---|---|---|---|
| Pigmented Lesion Treatment | Melanin | Shatters pigment clusters | Sun spots, age spots, melasma |
| Vascular Lesion Treatment | Oxyhemoglobin | Coagulates blood & collapses vessels | Spider veins, redness, rosacea |
| Mechanism of Action | Specific Wavelengths | Selective Photothermolysis | Targeted destruction, skin preservation |
| Device Requirement | High Specificity | Controlled Thermal Energy | Q-switched, Nd:YAG, Pico systems |
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- Precision Laser Systems: Diode Hair Removal, CO2 Fractional, Nd:YAG, and Pico lasers for flawless lesion removal.
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Partner with us to bring the science of selective photothermolysis to your practice. Contact BELIS today to find the perfect system for your clinic!
References
- Frederike Fransen, Albert Wolkerstorfer. Generic outcome set for the international registry on Laser trEAtments in Dermatology (LEAD): a protocol for a Delphi study to achieve consensus on <i>what</i> to measure. DOI: 10.1136/bmjopen-2020-038145
This article is also based on technical information from Belislaser Knowledge Base .
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