Page 55 - Chapter 3 - An Introduction to Laser/IPL Hair Removal

Chapter 3 – Fundamentals of Laser/IPL Hair Removal 1st Edition
Cooling the skin during photothermal treatments is a three-stage process:
Pre-cooling – before the laser energy is fired,
During – using a cold tip touching the skin and gel,
Post-cooling – with a cold flannel or icepack after the treatment.
Cooling is absolutely critical in all photo-thermal treatments! We are purposely over-heating the skin so we MUST take measures to prevent unwanted damage. Adopting the above cooling technique will reduce the chances of thermal damage significantly.
In addition, when using the above technique we can apply higher fluences which will increase the overall success rates. What this means, in reality, is that we must mitigate against all this excess heat energy in the dermis, before, during and after treatments. We do this by applying a proper level of cooling – contact cooling is the most efficient. Air cooling is fine but surface contact cooling with ice packs is at least twenty-four times more efficient at removing the excess heat energy.
Proper cooling will not only minimise any potential tissue damage but it will also improve the comfort level for the patient. In addition, it allows for higher fluences to be used, which may be required in certain procedures (such as for deeper follicles).
Figure 19 – When three skin colours are lasered by a diode laser at 20J/cm2, the basal layer of the epidermis becomes hot. By applying sufficient surface cooling for the appropriate times, we can minimise the effects of this excess heat in that layer. However, in the very darkest skin types, SC6, surface cooling may not be sufficient to counteract the very high temperatures generated in the epidermis. In such cases, an Nd:YAG is a much safer choice since the peak temperatures generated by this laser are much lower.
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