Intense Pulsed Light (IPL) is a treatment where a broad spectrum of light is applied to the skin. IPL differs to dermatological lasers in that they emit a large spectrum of light while lasers emit a single wavelength, but in practice they are quite similar. IPL machines are expensive and the treatments are normally only available from dermatologists and beauty salons. Using different settings IPL machines can be used for treating vascular lesions, fine wrinkles and also for hair removal. For vascular treatments the goal is to destroy blood vessels in the inner layers of the skin by heating them to 70°C. Although blood vessels are targeted, the light energy is also absorbed by other structures in the skin such as melanin (pigment for skin and hair) and water. IPL has only been around since 1995 and new research to maximise effectiveness while reducing side effects and new technologies and procedures are still being developed.
IPL machines are powered using a xenon flashlamp. Xenon, which is also used for camera flashes produces a flat spectrum of light from 400nm to 1200nm when excited with electricity. Different filters can be used to filter out lower wavelengths depending on the treatment performed. The size of the glass prism (spot size) varies between machines but at ~4.5x1cm they are much larger than typical lasers at ~1cm circle. A light pulse can be triggered by the operator using the hand piece. There is a delay between pulses while the capaciters recharge and the flashlamp cools down.
- Wavelength or Filter: A Xenon flashlamp produces a wavelength from 400nm to 1200nm. For vascular/rosacea treatments the light is filtered generally at the lower end. A 590nm filter would reduce the wavelength from 400-1200nm to 590-1200nm. Lower wavelengths penetrate lower and higher wavelengths penetrate more deeply into the skin.
- Fluence or energy level: The amount of energy applies over the whole pulse generally ranges from 20-60 joules per square centimeter (J/cm2) and may be spread over a series of short pulses. A joule is equal to 1 W·s (watt second).
- Pulsewidth: The duration of each pulse. Can be a single pulse or three short pulses.
- Repetitition rate: The delay between the short pulses.
Selective photothermolysis. The absorption of haemoglobin is significantly higher than the absorption by melanin the skins natural pigment. The haemoglobin absorb the light heating up causing the blood vessel walls to heat up causing coagulation of the blood vessels which are eventually reabsorbed by the body and replaced by scar tissue.
A cool numbing gel can be applied to the face prior to the procedure. This should cut down the discomfort about 50%. (The topical anaesthesia can be applied 10-30 minutes before the treatment). Eye protection is generally worn by the patient and the operator. The operator selects the settings based on the skin type etc. and proceeds with the treatment. Each pulse of the IPL feels like having a rubber band snapped against the face. The skin will be redder and painful after the treatment and improves over the day continues to improve for months after the treatment. Newer procedures include pre flushing using a heating pad on the back of the neck and macrolide antibiotics because of their anti-angiogenesis properties (which stop the regrowth of blood vessels shortly after treatments).
For men if the area of facial hair growth is treated then it could result in tempory stunted hair growth and possible hair loss.
If the patient has dark skin or has a tan or sunburn then this will reduce the effictiveness of the treatment.
If the operator presses too hard with the handpiece on your skin, the effectiveness of the treatment will be reduced because the blood will be pushed out of the area being treated.
If the energy levels are too high then purpura or brusing can result. Purpura is the appearance of purple discolorations on the skin caused by bleeding underneath the skin. Purpura can last up to 2 weeks. Blisters may also be caused if used inappropriately.
There is very little down time and the person treated may decide to go back to work immediately. Sunbathing should be avoided for the month after treatment.
Any ablative or such treatment can cause some temporary reddening of the skin, this should fade quickly without any particular treatment and make-up should cover it immediately. If the patient has any brown spots, they may get just a bit browner and darker for three or four days but they will remain dry and they just gently peel off. There is no oozing, weeping, or any other such inflammation. If there has been any increased pigmentary changes from this procedure, it should fade quickly or with simple bleaching.
- IPL - Intense Pulsed Light - all of these machines work basically on that principle.
- Photo rejuvenation - This is actually just a generic term implying that the skin may be rejuvenated using light (photo).
- Photoderm - This is just a generic marketing term and means nothing that hasn't already been described above. This could be any machine by any manufacturer.
- Photo facial - This is also a generic marketing term.
- FotoFacialTM - This is the only trademarked term for IPL.
A nonablative combination regimen of intense pulsed light and laser modalities safely treats photoaging in tanned and darker skin types, according to a recent study.
This finding is based on research conducted by Valeria Campus, M.D., and colleagues in Brazil. She presented these results at the annual meeting of the American Society for Laser Medicine and Surgery in Dallas.
For this study, Dr. Campus and colleagues set out to assess the safety of using intense pulsed light and lasers in patients with darker skin because there is a need for this kind of facial rejuvenation technique.
"A lot of people with dark skin color want to be treated, and most devices available are not able to treat them safely," said Dr. Campus, who teaches at the Universidade de Jundiai, San Paulo, Brazil.
The study involved 20 women with tanned or darker skin (Fitzpatrick skin types V and VI). Average age of the women was 48 years. The primary intent was to evaluate the safety of using these modalities to even out irregular pigmentation and rejuvenate the skin.
Each woman received just one combination treatment and were assessed by blinded clinicians after one and two months.
The combination treatment began with one pass of the intense pulsed light 640 nm (Quantum SR, Lumenis) over the entire face. The second phase of treatment was to target deeper rhytides with the Nd:YAG 1064 nm (Quantum DR, Lumenis). A cooling device was used on both instruments, and anesthetic cream was applied to all areas of the face one hour prior to treatment.
Dr. Campus chose these two devices, because "intense pulsed light works better in the upper layers of the skin, and the laser works deeper."
The researchers used a triple pulse approach for both the intense pulsed light and the laser. For the intense pulsed light, each of three pulses lasted 6 ms, with a 40-ms delay. For the laser, each of three pulses lasted 7 ms, with a 70-ms delay.
The intense pulsed light device that was used has a spectrum range of 560 nm to 1200 nm. Fluence is 20 J/cm2 to 45 J/cm2. Pulse duration can last between 1 ms and 12 ms, with a delay of 5 ms to 60 ms. The 1064-nm laser that was used has a fluence ranging from 70 J/cm2 to 150 J/cm2 Pulse duration can last 2 ms to 16 ms, with a delay of 5 ms to 100 ms.
Follow-up visits occurred one month and two months post- treatment. Photographs were taken, and subjects answered self-assessment questionnaires. Clinicians reviewed standardized digital photographs to assess wrinkles and pigmentation of treated areas.
Results showed that pigmentation improved and with limited side effects. However, wrinkles did not improve. Only mild hyperpigmentation was reported in one woman, and this resolved without any treatment within two months.
Answers to self-assessment questions showed that patients were pleased with the results.
"All women reported subjective improvement in the quality of their skin after one single treatment," Dr. Campus said. "The skin felt better, healthier."
While scarring or hypopigmentation is often a concern with rejuvenation of tanned or darker skin, that was not the case with this study population. "There was no scarring or hypopigmentation," she said.
One month after treatment, the researchers observed some degree of pigmentation clearance in 12 of the women. However, wrinkles did not visibly improve in any women after the one treatment.
"To improve wrinkles, it would be necessary to have several treatments," she said. "This study was done to check the safety of the technique. That is why it was done in just one treatment."
She suggested that, given the small study sample, further research is needed to verify treatment efficacy in a larger population.
Compiled and edited by:
John Sandham IEng MIET MIHEEM