High-power long-pulse 1064nm Nd:YAG laser systems function primarily through deep dermal heating via vascular targeting. By penetrating deeply into the skin, the laser energy is preferentially absorbed by oxyhemoglobin within dilated microvessels, creating a controlled thermal effect that stimulates the body's natural structural repair mechanisms.
Core Takeaway The specific 1064nm wavelength allows energy to bypass the epidermis and reach the deep dermis. There, it targets blood vessels to generate heat, which activates fibroblasts to regenerate collagen and remodel the atrophic tissue characteristic of Striae Distensae (stretch marks).
The Physics of Tissue Interaction
Deep Dermal Penetration
The defining characteristic of the 1064nm wavelength is its ability to penetrate tissue more deeply than shorter wavelengths.
This allows the laser energy to bypass the superficial layers of the skin and deliver energy precisely to the deep dermis, where the structural damage of stretch marks resides.
Targeting Oxyhemoglobin
Unlike ablative lasers that target water to vaporize tissue, the long-pulse Nd:YAG specifically targets dilated microvessels and the oxyhemoglobin within them.
By focusing on the vascular component often associated with early or persistent stretch marks, the laser converts light energy into heat specifically within the lesion's vascular network.
The Biological Response
Thermal Stimulation of Fibroblasts
The heat generated by the absorption of laser energy produces a controlled thermal effect in the surrounding tissue.
This thermal stress acts as a biological trigger, stimulating fibroblast activity. Fibroblasts are the primary cells responsible for synthesizing the structural framework of tissue.
Collagen Remodeling and Regeneration
Once activated, fibroblasts initiate the production of new collagen fibers.
This process, known as remodeling, gradually replaces the disorganized, atrophic collagen bundles of the stretch mark with new, healthy tissue. This improves both the texture of the scar and its overall appearance.
Understanding the Trade-offs
Photothermal vs. Photoacoustic
It is critical to distinguish long-pulse systems from picosecond systems.
Long-pulse systems rely on a photothermal effect (accumulation of heat) to stimulate repair. In contrast, picosecond systems (as noted in supplementary data regarding LIOB) use a photoacoustic effect to create mechanical shockwaves. For the mechanism described here, sustained heat delivery is the primary driver of efficacy.
Safety for Darker Skin Types
A significant advantage of the 1064nm wavelength is its lower absorption rate by epidermal melanin compared to shorter wavelengths.
This feature allows the laser to pass through the melanin-rich epidermis of darker skin types (Fitzpatrick IV and above) with a significantly reduced risk of thermal damage or pigmentation changes on the surface.
Making the Right Choice for Your Goal
When integrating high-power long-pulse 1064nm Nd:YAG systems into a treatment plan, consider the specific needs of the patient:
- If your primary focus is treating vascularized (red) stretch marks: The system is ideal because it directly targets the oxyhemoglobin in the dilated microvessels while stimulating collagen.
- If your primary focus is treating patients with darker skin tones: The 1064nm wavelength offers a superior safety margin by bypassing epidermal melanin to heat the deep dermis without burning the surface.
Summary: The efficacy of this treatment relies on the deep penetration of 1064nm light to thermally activate fibroblasts through vascular absorption, driving collagen remodeling from the inside out.
Summary Table:
| Feature | Mechanism/Detail |
|---|---|
| Primary Wavelength | 1064nm (Deep Dermal Penetration) |
| Target Chromophore | Oxyhemoglobin in dilated microvessels |
| Primary Effect | Photothermal (Heat accumulation) |
| Biological Action | Fibroblast activation & Collagen remodeling |
| Skin Safety | High safety profile for Fitzpatrick IV-VI (Darker skin) |
| Primary Indication | Striae Distensae (Vascularized/Atrophic stretch marks) |
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References
- Omneia Alaa Selim, Tarek Amin. Long-Pulsed Nd:YAG Laser as a Therapeutic Option for Striae Distensae. DOI: 10.33545/26649411.2025.v8.i2a.237
This article is also based on technical information from Belislaser Knowledge Base .
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