Diving into ablative versus non-ablative laser and fractional versus full field laser. Okay, that sounds "sciencey" but as you categorize this information, it becomes very simplistic to understand.
Classic ablative lasers are CO2 laser an Erbium lasers and they vaporize the top layer of the skin (epidermis) down to the dermal layer. They are considered the more aggressive type of laser, when compared to non-ablative lasers.
There are so many different types of lasers and this podcast introduces you to the concepts. With each subsequent podcast, we will delve deeper into different energy based devices so that you understand the downtimes and what these devices can and cannot do for you!
Hope you enjoy!
If you have any questions, don't hesitate to DM us at SalujalaserMD on instagram.
Thank you for your listenership!
Hi everyone Thank you so much for joining in on the inaugural podcast of our"Just Laser It and all things Cosmetic" My name is Dr. Minni Saluja and I'm here with Kane Rogers. How are you doingKane Rogers:
I'm doing really well and right next to me is our good buddy Link. He's our office dog and hanging out with us here today.Dr. Minni Saluja:
And hopefully he won't bark because let me tell you starting this podcast the content hopefully will be very easy to come by I mean we live and breathe lasers but the execution of a podcast my oh My has taken quite some hours so there's certain blips and blurbs that may not be able to be edited out so hopefully just kind of stick with us hereKane Rogers:
Yeah it's been an interesting experience watching you dive head first and understanding how to put together a podcast. But as with most things that you do you went all in and spent time doing research and so hopefully it'll go off without a hitchDr. Minni Saluja:
I hope so, Okay so what we're gonna do again the reason why I have Kane on this podcast as our co-host is that first of all Kane is my husband And he does run our practice He comes from a background of pharmaceutical marketing and sales and when Covid came around he decided that he wanted to make a career change So he runs our practice and he's also pursuing one of his passions which again you heard him mention about dogs He actually works with dogs in need Of care in need of vaccination et cetera but the reason why I brought him on was that Kane lives his life with one motto and I and I have a feeling that some of his pharmaceutical buddies can attest to this And that motto is Seek first to understand And that's kind of what we wanna do with this podcast is we wanna take the world of energy based devices and break it down and sift out all the noise and have you understand what these devices do and also just what cosmetic procedures in general do. So with that That's kind of the preface of why we're starting thisKane Rogers:
Yeah, You said a really important word There's a lot of noise the cosmetic space is always changing and there's always new technologies and innovations coming out and I think a lot of times people you know they know about the neuro toxins and the filler that's mainstream but a lot of people don't really understand the energy based devices that are out there and what they can do just to improve the overall quality of skin which I think a lot of times gets overlooked So certainly you've made a a career at being an expert in energy based devices and I'm sure everybody's excited to hear you explain a little more in detailDr. Minni Saluja:
Well let's dive right into it So the what we're gonna do is we're gonna kind of set up what we wanna talk about today And the two main points that I want you to walk away from today will be the understanding of A what a laser is but b what fractional what ablative lasers are and what non ablative lasers are What ablative lasers are and what non-ablative lasers are And I also want you to understand the difference between fractional delivery and full field delivery of laser So if we can kind of get an understanding about lasers ablative and non ablative fractional and full field I think that will be our topic for todayKane Rogers:
Yeah And just just to kind of set the stage you know we plan Releasing one of these about every two weeks We'll have we'll have a few up front so that you can listen to a couple of them right away And each episode's really only gonna last about 20 or 30 minutes We don't wanna overwhelm you with a a ton of information but we do want to keep you well informed because the more informed you are the better suited you are to make educated decisions with your provider for what's best for you So that's really the intent of this And if you like it please rate us and review it and subscribe and and hopefully we can grow this into something really specialDr. Minni Saluja:
Okay so now let's talk about lasers So sometimes folks will come in and they'll they'll say You know my friend had a laser done and I wanna have a laser done because she said that her skin looks great and lasers are not all encompassing In fact I'm gonna take one step back and say that everything everything that plugs into a Is an energy based device Lasers are a subcategory of energy based devices So for example you have lasers you ha that are one specific wavelength of light that are that's amplified and and we'll talk about the different wavelengths of light You have radio frequency devices which utilize electrical energy You have i p L's intense pulse light that use broad band light sources you have All sorts of different categories So lasers are one of these categories and so when we talk about ablative or non ablative and you'll often hear me talk about this If you think about ablative lasers a blade of lasers are basically vaporizing off the top layer of your skin the epidermis down to the dermis So you're basically taking that top layer of skin off. So this is a more aggressive type of laser when you think about thatKane Rogers:
when you say aggressive what does thatDr. Minni Saluja:
It just means that this is a little bit greater of a downtime laser And what I mean by downtime and again downtime can always be titrated based on the power of the you know the energy source that you're placing in And also the pulse durations kind of technical stuff. So we can always we can always work with the meters of the laser in order to make it go deeper and have a greater outcome greater bit of Tissue change or we can lessen the laser settings. Downtime is such a variable thing but what you can expect with an ablative type of laser is you can expect some downtime where if the depth is greater there's gonna be some pinpoint bleeding There's certainly gonna be some swelling you're gonna have You're gonna look scabbed up for about four to five days and then you'll certainly have a period where you're gonna be red for about anywhere from one week to four weeks depending on what type of settings are utilizedKane Rogers:
Well and it's it's interesting cuz I've you've done this on me and and you're my wife and I was like so shocked initially at the reaction that I had because I thought you did something wrong and it it turned out it was perfectly normal but when you say aggressive yes It was the swelling and the redness I was like Holy cow this really is an aggressive treatmentDr. Minni Saluja:
Okay so he brings up another good point How many of you all realize that friends and family are your hardest patients. And Kane is by far one of my hardest patients. But but what it does I mean I think it's really important In fact we try to set expectations that you will look like you know chopped meat for the first four to five days Again these are the higher energy ablative lasers So when you think about a blade of lasers we're talking about CO2 lasers You'll also hear about Erbium lasers. They they can ablate tissue at different depths CO2 typically goes deeper Erbium can be titrated to go a little bit deeper as well but these are the type of lasers that that can go deeper in the skin. Again this is ablative laser where we're vaporizing the tissue surface now what's important is these type of lasers As much as I love love love my CO2 laser, unfortunately I cannot use it on my skin because I have darker skin color And so if I utilize this laser on my skin I can end up with something PIH, post-inflammatory hyperpigmentation. So while these lasers exist it's also important not to just say if a patient comes in and and will tell us my friend had a co2 I want a co2 but perhaps their skin is not the appropriate type for a co2. So these are the conversations that have to be hadKane Rogers:
Well so you mentioned the downtime and the swelling that can occur and and as I said it was I was kind of quite shocked that initial day but why would somebody even consider getting something that's so aggressive. We're talking about the downside of it but what's theDr. Minni Saluja:
So the upside is when you're utilizing these lasers you're targeting dermal water you're ablating the tissue and what you're doing is you're basically giving a patient a controlled wound that stimulates elastin and collagen in their skin. So the wrinkles that you see the fine crepey skin these can really be improved with a series of lasers typically I say you do need a series Now sometimes with co2 if it's a high level one you might only need one. But then six months a year later you you might decide that you need another one to augment the the collagen production. But that's the upside of it is that these lasers and again laser the acronym for laser is light amplification with the stimulated emission of radiation and it's usually one wavelength of that's amplified that's targeted to the tissue that actually is picked up by certain chromophore of the skin and the targets or the chromophores of the skin are melanin which are the pigment spots hemoglobin which are the broken capillaries and then of course dermal water which are basically the wrinkles. So ablative lasers are wonderful wonderful In in resurfacing the skin and improving the skin qualityKane Rogers:
is there a is there a typical patient that you would say you know this would work really well for you Or is it one of those treatments that you know anybody can really get one. Or is there is there a particular patient where you think this would be more beneficial.Dr. Minni Saluja:
Well I definitely think that patients who have deeper wrinkles and who have acne scarring those are the the the patients that you wanna go a little bit deeper in this in the skin tissue those are appropriate for this. Or periocular wrinkling I love CO2 lasers for that I love other things as well. But it has to be a patient again that pretty good dermal health right. You don't wanna It's almost like when you start a a fitness program. You don't wanna pick up a 50 pound weight and start curling weights curling if that's the right word. Doing bicep curls with it. But you wanna be able to start with maybe 10 pound weights and work your way up So the same thing with lasers If.I find someone has a really poor dermal health I wanna start them on a little bit of Retin-A a little bit of tretinoin and get their skin in better condition. And then maybe even start Non ablative lasers which we're gonna delve into next to try to get their skin in better skin quality and then perhaps graduate them to an to an upper laser.Kane Rogers:
Okay so let's talk about the non ablative. You just mentioned it Tell us a little bit about that.Dr. Minni Saluja:
Okay so ablative you know vaporizes the skin surface non-ablative laser leave the skin surface intact. So what it's doing is it's delivering energy again targeted down to that dermal water. And these are with the specific wavelengths of light that get down to that that dermal water and it can stimulate collagen elastin but the top layer remains intact. Now this is really important especially when you're dealing with darker skin types. My skin I typically will use non-ablative lasers or I will use radiofrequency microneedling We'll talk about that at a future episode. But this is perhaps a little lesser downtime. Now you can still swell and you can still get red from this but you don't need all the post care of the emollients that we use with ablative lasers with the non ablative laser. Now the other thing that we're gonna talk about are fractional and full fieldKane Rogers:
So So when you talk about ablative that it's very aggressive and non-ablative isn't necessarily as aggressive what kind of results would you expect with a non-ablative versus an ablative. Would for instance would you need more treatments of the non-ablative to get a similar result to the ablativeDr. Minni Saluja:
You do need more treatments to get to result.Your result still though you even if you did 10 treatments with non ablative it may not achieve what you can do with an ablative. It's just a different skin type of reaction that you get. So again if you wanna get a little more aggressive with the skin I would go with the ablative on the right On the right skin color but non ablative lasers you can get some nice results I mean three to five treatments you can get some really nice results. Typically we deliver these type of lasers every four to six weeks or so. So yes you can get some nice results It's just a little lesser downtime but not quite at the level of your ablativeKane Rogers:
So that's that's kind of the difference If if I'm summarizing it and hearing what you say correctly like ablative is more aggressive more downtime good results and non ablative is less downtime pretty good results may may get very similar results but it's just gonna take you more treatmentsDr. Minni Saluja:
Correct And you know what's so interesting is that our lives have become so busy so it's really really difficult. There are times patients will come in they'll say Dr Saluja I really wanna do an ablative but I have got a meeting this day I've got a Zoom call this day. So that's where non ablative or even lower level fractional ablative can can make a make a real big impact where you don't have that big downtime. But let's go back to fractional. So about 2003 2004 Dier Mansen came up with the concept that okay we if we do a laser pulse on the skin full field meaning that where you put the pulse down the entire area is covered that's a full field which was utilized initially with ablative lasers Really really long down times and carried a higher risk of of hypertrophic scarring demarcation lines et cetera. But he applied it to first non-ablative and said What if we fractionated this technology. What if we placed these little pulses down in pixelated fashion meaning that there are zones of where the tissue is encountered with the laser and there's intervening zones where there's no energy placed at all, But rather you have the thermal spread Could we then have lower down times and use higher settings and it really achieved some nice results. So that's where fractional technology came And what they did was again first applied to non-ablative but then when I was doing my fellowship. I so my background is I'm a board certified ophthalmologist I went back and I did a cosmetic dermatology fellowship with Mitch Goldman out in San Diego. One of the best things I ever did in my life and when I was out there this was 2007 that's when fractional technology was just being applied to ablative lasers. And so the first laser out there that we utilized was an Fx Deep FX Lumenis and we did a lot of studies on it. We looked at the histology that we were getting when we titrated different powers and energy settings and we published a paper looking at these that show that okay if we can increase power we increase depth. If we increase our pulse ations we can actually increase the width the injury that we're placing down in it and we can modulate how our down times are how our end results are so it was such a super exciting time to have this fractional technology applied to ablative SoKane Rogers:
help me understand like when you talk about fractional technology again how does this how are you what's the typical patient. What's what are you looking for when you would want to apply this type of treatmentDr. Minni Saluja:
So in our practice I don't do full field I I primarily do fractional technology. The only time I do full field and again it's a later episode is when I do plasma energy. But or we'll talk about tattoos and or when I do tattoo but otherwise all of our modalities are with this fractionated technology because again you still have significant downtimes with ablative but it is much easier to control those downtimes and remember fully ablative boy you have to wear I remember having to bring patients back on a daily basis change out their silon masks. They were really red for months at a time not just weeks but for months at a time. Now granted the results were absolutely stunning issues and the problems were absolutely disastrous when they would occur. So non-ablative is a safer way Everything we do is is is I'm sorry fractionated is a safer way So everything we do is fractionated in the practice both in ablative and non ablative So that kind of summarizes what we're trying to get to with lasers Again there's different wavelengths of light. We choose these different wavelengths of light in order to target specific chromophores as I really wish we had one laser that could do it all but that is not the case and that is why in our practice we have umpteen different lasers so that we can Give you the type of result that you that we wanna get you toKane Rogers:
You'll hear us talk about energy based devices because laser as as Dr Saluja just said earlier is just one component of an energy based device. There's many many others And as we continue in future episodes we'll dive in more into the other options as well.Dr. Minni Saluja:
Right so again ablative non ablative fractionated and full field. And hopefully this will at least give some understanding of this And in our next episode we'll we'll go in a little bit more But thank you so much for joining us for the first little episode of just Laser IT and all thingsKane Rogers:
cosmetics and if you enjoyed it please rate review and subscribe and we appreciate it Hope to hear you soonDr. Minni Saluja:
Thank youKane Rogers: