Laser controversies: Separating truth from hype

For many controversies surrounding laser treatments, there are no black-and-white answers. What works for one physician or patient may not work for another, says an expert.

"With any problem one is treating, there are always going to be people who do not respond to whatever method one currently uses," says Eric F. Bernstein, M.D., director of Laser Surgery and Cosmetic Dermatology Centers in Philadelphia and New Jersey and clinical associate professor of dermatology at the University of Pennsylvania. For this reason, he recommends listening to experts' opinions to learn about other options.

HAIR REMOVAL

"The reason it's controversial is that, like any other field, there's a lot of art in laser surgery. People have variable opinions," he tells Dermatology Times.

If a patient's hair is changing (shrinking in diameter) throughout the treatment, Dr. Bernstein says, "I often switch lasers, and which one I use in a given situation will depend upon the diameter and pigmentation of the hair, as well as the patient's skin type."

The frequency of treatment for hair removal depends on the area of the body one is treating, he adds.

"For example," Dr. Bernstein says, "facial sites may require more frequent treatments than the legs or back."

Perhaps equally controversial is the question of whether radiofrequency (RF) has a role in hair removal, Dr. Bernstein adds. "I still remain to be convinced. My question is, who does use it, and how? There are many ads bombarding people, and nobody really knows what's right."

BLOND, WHITE HAIR

Another question that often sparks heated discussion is whether one can remove blond or white hair with lasers or RF, according to Dr. Bernstein.

"I tell my patients I can't do that. I like to hear what other people have to say on this subject."

TATTOO REMOVAL

For tattoo removal, he says plastic surgeons currently use three main Q-switched lasers.

"The question is, how good is the state-of-the-art for tattoo removal? Can we remove multicolored tattoos effectively and easily?"

For some patients, Dr. Bernstein says, this is possible. However, he adds,"We must come a long way from where we are with tattoo removal. It takes a lot of treatments. And especially for multicolored tattoos, we all wish we could do it better, with fewer treatments."

LEG VEINS

For spider veins in the legs, Dr. Bernstein says, "Some people never use lasers, only sclerotherapy."

In fact, he says that half the patients he treats for leg veins already have been treated with sclerotherapy.

Usually, he says, "I'm removing the little matt telangiectasias that appeared as a result of the sclerotherapy."

As for larger leg veins, he says controversy swirls around how to use lasers such as the Nd:YAG.

"And what's the role of the Nd:YAG laser in removing red telangiectasias?" he asks. "I don't really use the 1,064 nm laser for this purpose." Many companies promote this laser because it treats hair and veins, Dr. Bernstein reports.

Nevertheless, he says, "It's not my first choice for most hair removal patients or for treating leg veins. I like sclerotherapy (or stripping) for the large veins and laser for the smaller ones."