Serendipity

In the early 1990s within a decade of the marriage of surgeon and industry serendipity reminded us that not all laser developments are predetermined rationally. In 1993, Alster reported that, when treating hypertrophic, persistently red scars for the erythema with a pulsed dye laser, she obtained not just improvement of the erythema but a distinct textural improvement, so much so that the scars flattened, occasionally dramatically, after several sessions (299). At first argon laser induced...

Biostimulation

Numerous European authors, most prominently E. Mester in Hungary, have studied bios-timulatory effects of lasers on cutaneous tissues in vivo and in vitro since the mid-1960s (425-428). Beginning with the long-pulse ruby, then the He-Ne and argon lasers, he performed studies on 15 different biologic systems, such as Erlich's ascites tumor cells, hair growth in mice, rat marrow hemoglobin synthesis, human fibroblast RNA and DNA protein synthesis, and wound healing, first reporting his results in...

Laser Hair Removal

When Q-switched ruby lasers were employed in large numbers in cutaneous laser surgery another serendipitous enlightenment occurred. The immensely powerful though short bursts of energy generated to fragment tattoo particles were noted not only to vaporize darkly pigmented hairs but also to bleach them below their follicular exit and even to inhibit their reappearance. Studies by Dover et al. (271) in 1989 had shown selective pigment cell damage in follicles from this laser, which caused the...

Qswitching

In 1967 Leon Goldman (38) published his 3-year experience with the long-pulsed 1.8 ms ruby laser and the neodymium laser to treat tattoos, producing nonspecific histologic necrosis and subsequent fibrosis with decreased pigment. In 1964 Goldman had already first compared the normal mode and the new Q-switched ruby laser (37) on tattoos. By increasing the power density, he was able to show permanent tattoo pigment removal with the Q-switched ruby laser by 1967 (38). In 1967, a full 15 years...

NdYag Laser

The Nd YAG laser was first used by Goldman in studies on tattoos shortly after its invention in 1961. Though used primarily in endoscopic gastrointestinal laser surgery, particularly for bleeding, since it had such deeply penetrating nonselective thermal necrosis of almost 4 mm when used in normal mode, Landthaler et al. (189) in Germany in the mid-1980s first advanced its use for therapy of large vascular cutaneous tumors. These cavernous hemangiomas (252-258) or large blebs of port-wine...

Info

Einstein's conceptualization of stimulated emission of radiation Theory of coherence Dirac Theory of amplification Townes (USA), V. A. Fabrikant (USSR) Optical resonator Schawlow and Townes First gas laser, He-Ne, at Bell Labs Ruby laser used on port-wine stain Leon Goldman Microscope coupled with ruby laser Bessis and Coll First commercial production of lasers 1962 Laser research laboratories founded 1963 Low-power lasers and wound healing Endre Mester 1964 First article on laser surgery of...

Wellman Lab And Beckman

Although Rox Anderson first immersed himself in lasers as an undergraduate student in 1976, in the Wellman Labs of Photomedicine (www.wellman.mgh.harvard.edu), of which he is now the research director, had opened at Massachusetts General Hospital (MGH) in Boston in 1974 as a multidisciplinary research laboratory devoted to basic and applied research in human photobiology. It is now the world's largest biomedical laser research facility as well. In 1988 a laser applications research laboratory...

Chilling And Wrinkles

Laser technologies seem to have a knack for recapitulating. Just as the ruby laser reappeared in the late 1980s after a 20-year hiatus, so renewed interest in green lasers for vascular lesions and a renewed understanding of the importance of chilling reappeared in the mid- to late 1990s, particularly by Wellman Lab (199,200) and Beckman Lab. Part of the interest in chilling was fostered by the large amounts of energy required to destroy or alter hair follicles and the need to protect the...

Contents

Foreword Preface Acknowledgment List of Contributors 1. Cutaneous Laser Surgery Historical Perspectives 3 2. An Introduction to Lasers and Laser-Tissue Interactions in Dermatology 59 Christie Travelute Ammirati and George J. Hruza Section II Laser Science and Instrumentation 4. Continuous Wave Lasers Argon, Dye, KTP, Copper Vapor, Krypton 105 5. Continuous Wave and Pulsed CO2 Lasers 129 Ulrich Hohenleutner and Michael Landthaler Kristen A. Richards and Jerome M. Garden 8. Clinical Uses of the...

It Takes A Nobel Prize Winner To Think Of It

Green Nobel Prize Goldman

Albert Einstein (Fig. 1.1) (14-18), Time Magazine's outstanding persona of the 20th century, also had the first insight into what has become our 21st century world of lasers. He elaborated the concept of stimulated emission of radiation in 1917 (19,20) wherein he postulated that if an electron were in an already excited state and were hit by a photon of the proper energy, instead of rising to a still higher energy level, it would fall to a lower level and emit a second photon of precisely the...

Pigment Lasers

The high prevalence of unsightly pigmented lesions such as solar lentigines, flat seborrheic keratoses, cafe au lait macules, and even nevi offered a large spectrum of potentially treatable lesions and spurred the boom in the use of pigment-targeting lasers. Q-switching was not essential for melanocyte destruction but allowed for more intense focal melano-some injury and lesser risk of scarring, but continuous wave green argon, KTP, krypton, and copper vapor lasers had been widely used in the...

Postoperative Wound Care

As noted before, interpretation of adverse events when continuous wave lasers were employed for cutaneous laser surgery and epidermal necrosis ensued became obscured by the fact that scarring was underreported or redefined and postoperative care was not standardized, not mentioned in the literature or in lectures, and sometimes not given. Second-degree thermal wounds all scar and it is likely that the absence of postoperative dressings over the necrotic wound in early argon laser surgery was...

List of Contributors

Center for Laser Surgery, Washington, DC, USA Murad Alam, M.D. Department of Dermatology, Northwestern University, Chicago, Illinois, USA Macrene R. Alexiades-Armenakas, M.D., Ph.D. Private Practice, New York, New York, USA Tina S. Alster, M.D. Dermatology and Pediatrics, Georgetown University Medical Center, Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA Christie Travelute Ammirati, M.D. Division of Dermatology, Penn State University...

Return Of The Scientific Methodthe Charge For The Future

Industrial hyperbole and the seeming need by many cutaneous laser surgeons to be the first kid on the block by presenting anecdotal evidence for a new use of a particular laser (148), whether justifiable biologically or financially for the patient, swung the pendulum of laser activity and continues to do so at a violent pace toward the nonsense pole antithetical to Leon Goldman's maxim. In recently reviewing laser skin resurfacing, Kauvar (324) bemoaned and warned that rapid development of...

Cutaneous Laser Surgery Historical Perspectives

Mount Sinai School of Medicine, New York, New York, USA 1. Finding the Right Thread in the Cloak 4 2. It Takes a Nobel Prize Winner to Think of it 4 5. Multidisciplinary Societies 15 5.1. Laser Institute of America 15 5.2. International Society for Laser Medicine and Surgery 15 5.3. American Society for Laser Medicine and Surgery 15 6. Laser safety The American National Standards Institute 16 7. Personnel and Patient Safety Plume 17 8. Patient Safety SCAR 17 9. Postoperative Wound Care 22 10....

CO2 Laser

The CO2 laser was invented by Patel (86-88) (Fig. 1.8) of Bell Labs in 1964, but the first surgical CO2 laser was developed by Polanyi et al. (89) in 1965 and was first exhibited in 1967. Jako (90) noted that the earliest laser work in otolaryngology was by Stahle and Hoegberg (91) in 1965, using a pulsed laser for inner ear irradiation, Conti and Bergomi (92) in 1966 for the posterior labyrinth, and Sataloff (93) in 1967 for otosclerotic stapes. About the same time in 1965 he first began...

Argon Laser

Bennett et al. (53) invented the blue-green argon laser in 1962. It was first used on the eye by L'Esperance (54) in 1967. This laser became commercially available in 1971 (55) and was the first laser to be widely used for treatment of cutaneous disease once the initial excitement, and unfortunately concurrent disappointment, with the ruby laser had passed, which had proven to be uncontrollably too destructive for skin disease in its original industrial format. Reports by Apfelberg and...

Patient Safetyscar

The argon laser had not been developed specifically for the treatment of cutaneous disease but was used mostly for spectroscopy. Most manufacturers were supplying instruments with 1 or 2 mm spot sizes with 0.1 s being the shortest pulse duration shutter speed . Even with the minimal dose technique of Cosman 71,72 , wherein one selected the lowest power setting to produce a visible whitening of the skin after laser impact, one had to depend on this visual signal which reflected not vascular...