Rosacea
This chronic skin disease affects 3% of French people, mostly fair-skinned women. There are several stages in rosacea, which ranges from some diffuse redness (erythrosis) to permanent redness with dilated vessels (rosacea), to redness with papular lesions (rosacea).
Stage 4, thickened skin with blisters on the nose, affects men more. When the erythrosis is extensive with many dilated vessels, vascular lasers are the most suitable.
“These lasers which target red, and more particularly oxygenated hemoglobin, destroy the vessel wall either by ‘sclerosis’ (selective photocoagulation) or by bursting (selective photothermolysis). Depending on the type of lesion, we don’t use the same type of machine,”explains Dr. Nathalie Gral, dermatologist.
The pulsed dye laser, which causes photothermolysis, treats small vessels. It leaves round purple spots (purpura) which remain highly visible for 10 to 15 days. KTP laser is preferred for dilated intermediate vessels while Nd:YAG laser is used for larger caliber and deeper dilated vessels. Both work by photocoagulation and leave the skin swollen for 2 weeks.
Two sessions are usually required, spaced 4 to 6 weeks apart.
However, in case of rosacea (stage 3), the dermatologist begins with a treatment with antibiotics and treatment cream for at least 1 month before moving on to the laser. “In stage 4, we go to the ablative CO laser under local or general anesthesia, which will “sand down” the hypertrophied layers one by one and requires eviction and dressings for two weeks”, says Nathalie Gral.
How much does it cost ? From 150 to 400 € per session depending on the area.
Contraindications: Tanned skin or sun exposure, inflammatory rosacea or herpes outbreak, anti-acne treatment with oral isotretinoin.
angiomas
” THE angiomas stellate (small central vessels that deviate in a star) can be eliminated by electrocoagulation in the center and pulsed dye laser around in 1 to 3 sessions”, explains Dr. Gral. As for flat angiomas (port wine stains), they can be treated with a pulsed dye laser (with purpura), with at least 5 sessions spaced 1 to 3 months apart, the clarification taking place gradually. Ruby angiomas, due to a small proliferation of vessels, are treated with the KTP laser.
Varicosities
These visible venous minicapillaries, red or blue in color, varicosities are not to be confused with varicose veins, which are much larger.
“Sclerosis – by microneedling – remains the reference treatment,explains our expert. And it is best to consult an angiologist and do a Doppler ultrasound before any laser treatment. Nd:YAG laser treatment is also more expensive and does not hurt less than sclerosis. »
The Nd:YAG laser can be used in addition to sclerosis and in patients allergic to sclerosing products. You have to wait more than 2 months before seeing the final result.
How much does it cost ? Count between 120 € and 200 € per session.
brown spots
These brown spots are often called “age spots”. They are actually solar lentigines because they are caused by repeated exposure to the sun (photoaging). If some dermatologists still burn them with liquid nitrogen, fast and inexpensive, but with the risk of reactive hyperpigmentation, the pigment laser (Q-Switched or triggered) has become the reference treatment for hyperpigmentation, particularly well suited when the brown spots are scattered and deep.
It can also be used to treat seborrhoeic keratoses, “birthmarks”, and certain nevi (Becker’s, Ota’s). On the other hand, “we never treat melasma (or pregnancy mask) with laser or with any light, at the risk of increasing it with a pigmentary rebound”,notes Pr Thierry Passeron, dermatologist.
In this case, the solution is a peel.
The beam targets the melanin and “pulverizes” the pigment from the spot without burning the surrounding skin. The most common is the Q-Switched Nd:YAG laser, but “with a Pico laser (which strikes in picoseconds and not in nanoseconds), the treatment and its aftermath will be shorter, with less scabs and redness”,says Dr. Hugues Cartier, laserist.
The treatment must be carried out on detanned skin. The skin is slightly swollen for 2-3 days, then small crusts appear and fall off in 10 days. Prohibition of sun, active irritants (AHA, retinol) for 1 month. And SPF 50 essential.
How much does it cost ? Count several sessions spaced 4 weeks apart, from 150 € to 300 € per session.
Contraindications: Taking photosensitizing drugs, an anti-acne treatment with oral isotretinoin (it is necessary to wait 1 year before programming a laser, because this drug promotes hypertrophic scars), black skin (phototypes V and VI).
Acne
Pimples, microcysts… Acne concerns 80% of adolescents, but also more and more adult women who do not necessarily wish to go through heavy treatments such as isotretinoin (Roaccutane®), which dry out and damage the skin and are responsible bothersome side effects.
In addition, their acne is more of an inflammatory type than a retentional one.
Before any attempt to switch to laser, a visit to the dermatologist is necessary. Nevertheless, recent clinical studies have demonstrated the usefulness of certain lasers in the treatment of inflammatory acne breakouts. The main interest, compared to drug treatment, is to target only the affected areas, without general side effects. Infrared lasers alter the sebaceous glands responsible for the overproduction of sebum, while KTP or pulsed dye lasers stem the proliferation of the bacteria C. acnes. However, the laser is not intended for beginner or retentional forms of acne.
How much does it cost ? From €150.
Acne scars
Acne scars can be hyper-pigmented (red in light skin, brown in dark skin), but also hollow: “V” (or “ice pick”, like fine holes) or “U” (in crater), giving a pitted appearance to the skin.
For red scars, we will turn to a vascular laser, for brown ones, to a pigment laser. For those in hollows, if microneedling and injections of hyaluronic acid in “droplets” can improve some of these scars, the non-ablative fractional laser is today one of the preferred techniques.
The process is based on the creation of multiple microwells of heat, separated by intervals of healthy skin, which will stimulate the production of neocollagen, thus gradually filling in the scars. Then the skin is red, like a sunburn, and rough for a few days. Several sessions are usually required.
How much does it cost ? Around €400 per session.
To know : The French Society of Dermatological Lasers has launched the website Laser-and-skin.com to offer the general public complete information on lasers, IPL and LEDs for dermatological and aesthetic purposes.
