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Idea of LASER (General Principles and Physics) laser

What is LASER?

LASER = Light Amplification by Stimulated Emission of Radiation.

A LASER-equipped device can generate a high-intensity light that is monochromatic, unidirectional, and parallel.

Laser physics Light Amplification by Stimulated Emission of Radiation

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History of Using LASER in medical field!

- The ruby LASER was the first medical LASER when it was used in 1963 to coagulate retinal lesions. Other substances were found that could serve as the active medium of a LASER device. Many substrates, especially rare earth elements such as erbium (Er), gadolinium (Gd), holmium (Ho), praseodymium (Pr), thulium (Tm), uranium (Ur), and ytterbium (Yb), have been used successfully.
- The first gas LASER, which was also developed in 1961, used a mixture of helium and neon. Its red color allowed it to be used as an invisible LASER. Currently, it is used to relieve pain and promote wound healing.
- In 1962, the argon LASER was developed. This LASER emitted energy in the blue-green portion of the electromagnetic spectrum. Energy with wavelengths in this part of the spectrum is more readily absorbed by 2 naturally occurring chromophores (absorbing pigments) in the human body-melanin and hemoglobin-than by the surrounding tissue


The Physics of Medical LASER!

Physics of Medical LASER


Basic Components of Medical LASER!

The basic LASER device consists of 3 components:

(1) an active medium, or lasing medium; may be a solid, liquid, or gas. Different active media emit different energies or wavelengths of light.
(2) an optical cavity, or resonator; contains an active medium. At each end of the resonator, parallel reflectors or mirrors are placed facing each other. The front of the output mirror is designed to be partially reflective. It reflects only a portion of the light impinging on it, allowing some portion of the total energy or light to escape. The rear mirror is a total reflector that reflects 100% of the energy impinging on it.
(3) an energizing source, or pump, provides the energy (thermal, electric, or optical [e.g. a flash lamp]) for absorption by the active medium.

Basic Components of Medical LASER



Mechanism: energy pump activates the active medium lead to spontaneous emission of photons. Some of these photons are reflected back and forth between the 2 mirrors. At the front output mirror, a portion of the energy is permitted to escape. This energy is in the form of an intense beam of monochromatic (same wavelength), collimated (parallel, nondiverging), and coherent (same direction) = LASER.


LASER Beam Properties (Measurements):

- Energy is proportional to the number of photons and is measured in joules (J).
- Power the rate of delivery of the energy, is measured in watts (W) where: 1 W = 1 J/Sec.
- Irradiance = power per unit area and is measured in W/cm2.
- Fluence = the energy delivered per unit area and is measured in J/cm2.


Types of LASER(Wavelength):

- The effect of light on skin depends on the wavelength of the light.
- Light in the UV region (100-400 nm), invisible, cause deleterious effects such as erythema, hyperpigmentation, and skin tumors.
- Light energy in the visible spectrum (380-700 nm) is mostly innocuous, but it can be absorbed and cause thermal damage when it is delivered to the skin at a high intensity.
- Light in the near IR region of the spectrum (780-3000 nm), also invisible, causes skin and retinal defects.

Types of LASER

- Because the LASER is monochromatic and because it has a very narrow bandwidth, it permits selective targeting of chromophores in the tissue for treatment. This property is one of the underlying principles of selective photothermolysis (SP).

- Chromophore: is a chemical substance of the molecule that give it its color. i.e. Hemoglobin and melanin are natural endogenous chromophores while Tattoo ink is exogenous chromophore.

- The degree of absorption and its thermal effect on skin vary with the amount and type of chromophores that are present in the recipient.

- Different chromophores have different absorption coefficients =”a measure of the degree of absorption by the chromophores at a particular wavelength”.


Complementary Colors and subtractive color mixing:

Newton's hue circle completely requires that every spectral hue will have a single spectral opposite (or mixture of two opposite spectral hues) that can combine with it to create white light.


 

Complementary Colors and subtractive color mixing


- Newton stated the definition of complementary colors that is still used today: any two hues that, mixed in the right proportions, produce a "faint anonymous" neutral (pure white, gray or black) color. (i.e. yellow + blue and red + green).

- Light color mixing is different from color mixing in substances: three monochromatic lights (blue 460nm, green 530nm and red 650nm)

- How do we determine the exact complementary color for any color we choose? The simplest way is to determine quantities of the two opponent processes that determine the chosen color (redC1 + yellowC2)=(orange), then identify the color that is produced if we apply the same quantities to the opposing process hues (greenC1 + blueC2) = (greenish blue) .

- subtractive color mixing: A subtractive mixture absorbs all light wavelengths that each colorant absorbed by itself. There is one general rule we can rely on, however "When we materially mix paints, dyes or filters, we do not increase their light reflecting (transmitting) behavior but their light absorbing behavior".


Selective Photothermolysis Theory:

- In 1983, Anderson and Parrish described the theory of Selective Photothermolysis (SP) is a method for localizing tissue damage to specific chromophore targets at the cellular level; therefore, it can be used to minimize undesired thermal damage to the surrounding tissue caused by thermal diffusion.

- The mentioned LASER parameters [power density, fluence, and wavelength] are the fundamental principles in the operation of medical Lasers in the concept known as SP.

Thermal Relaxation Time (TR): the time required for a given heated tissue to lose 50% of its heat through diffusion.

- Therefore, if the duration of the LASER pulse is less than TR of the target tissue then thermal diffusion is less and also the non effective thermal damage to the surrounding tissues.

- It is measured in terms of the area (r =radius of target area) affected and the thermal diffusivity (D) of the target tissue, as follows:
                                                         TR = r2/4D

proper SP


MODES of LASER: CONTINUOUS WAVE (CW), PULSED, and Q SWITCHING:

- A Continuous-Wave (CW) LASER: continuously pumping energy into the active medium to achieve an equilibrium between the number of activated atoms and the number of photons emitted. The duration of a CW LASER pulse is approximately 0.25 second.

- Pulsed LASER: deliver high-energy beams in very short pulses in range of milliseconds without the use of a shutter.

- Q-Switch LASER: Both types of can be further modified to produce even shorter pulses, usually in the range of 10-250 nanoseconds.


Skin Optics:

Light that directed to the skin may be reflected, transmitted, scattered, or absorbed at each layer. Only absorbed light produces tissue effects.

- The epidermis reflects approximately 4% to 7% of visible light that encounters the skin.
- The dermis predominantly scatters light because of the dense collagen content.
- Within skin, there are endogenous and exogenous chromophores.

- Absorbed light energy can produce thermal, mechanical, and chemical changes in skin:

- Thermal effects: range from protein denaturation to vaporization and carbon formation.
- Chemical reactions: produce chemically reactive excited state molecules, as in photodynamic therapy.
- Physical or mechanical “photoacoustic changes”: is caused by rapid thermal tissue expansion, creating pressure waves that fragment pigment particles in the dermis.


Applications of LASER in Plastic Surgery Field!

 For those who are considering Any Laser Treatment, they should consider:
- Who will perform the treatment?
- Which exact device will be used?
- The setting in which they intend to undergo the procedure.
- And, especially, what is the training level of the team that's going to be doing the procedure?


Laser Type 

Wavelength (nm)

Color

Chromophore

Application

Argon

488/514

Blue

Melanin & hemoglobin

Vascular lesions

Long Pulsed dye

510

Green

Melanin

Pigmented lesions
Tattoo removal

KTP/double Ferq Nd:YAG

532

Green

Melanin & hemoglobin

Pigmented lesions
Vascular lesions

SmartLipo

Copper vapor

578

Greenish-yellow

Melanin & hemoglobin

Pigmented lesions
Vascular lesions

FLPPD

585

Greenish-yellow

Melanin & hemoglobin

Vascular lesions

Long pulse

595-600

Greenish-yellow

Melanin & hemoglobin

Leg Spider veins

Ruby, Q-switched Long pulse

694

Red

Melanin

Pigmented lesions
Hair removal

Q-switched Alexandrite

755

Red

Melanin & hemoglobin

Pigmented lesions
Tattoo removal

Nd:YAG

1064

Mid-Infra Red

Melanin & hemoglobin

Pigmented lesions
Deep vascular

SmartLipo

Q-switched YAG

1064

Mid-Infra Red

Melanin & hemoglobin

Pigmented lesions
Tattoo removal

Er:YAG

2940

Infra Red

Protein (Scattered)

Skin resurfacing

CO2 

10600

Infra Red

water

Cut/coag Surgery
Skin resurfacing