See the (Laser) Light by Elvira Maricic From major scar removal to minor hair removal the increasing use of lasers can result in both serious and not-so-serious improvements in patients' quality of life print article      send to a friend

Welser was no stranger to laser procedures. Her husband, Paul, had the same LASIK (Laser-Assisted In-Situ Keratomileusis) surgery a month before she did, and their 21-year-old daughter soon followed. This family affair with lasers is representative of the growth in popularity and increased availability of refractive and aesthetic laser procedures.

Although lasers have been around since the 1960s, it was the development of Excimer and pulsed or scanned CO2 lasers in the mid-'90s that made lasers a mainstream part of physicians' practices. Today, in addition to laser vision correction surgery, lasers are routinely used for skin resurfacing, hair removal, and even treatment of periodontal disease.

Making life a little easier

When Mikhail Gorbachev was a child, his parents didn't have the option of taking him to a dermatologist to remove his unbecoming birthmark. Fortunately, with the advances in laser technology, children today don't have to suffer the taunts of vicious grade-schoolers, since lasers can be used even on patients less than six months old.

"We can use a variety of lasers to treat a variety of different lesions," notes Sunila Walia, MD, a practitioner with Dermatology Associates of Atlanta. "We have vascular-specific lasers which basically target blood vessel lesions (such as port wine stains), facial blood vessels (like telangiectasias), fibrous papules, and rosacea.  We can use lasers to treat scars, especially when they're very red and very raised, and sometimes even to treat stretch marks. We can even use them to treat warts," she says. "We use our pigment-specific laser, called a brown spot laser, to treat various sun spots, and we use it to treat a number of different congenital moles. We also use it to treat tiny moles. We also have a hair removal system. They're very good at the upper lip, the bikini line, and we even do the back, targeting the pigment cells and hair follicles," Walia adds.  

Lasers can also be used to remove youthful indiscretions. In the past, if you had "Stella" tattooed on your biceps and you ended up marrying a "Marge," there wasn't a whole lot you could do about it. Fortunately, today's technology can spare you those daily withering looks, since laser tattoo removal with an Nd:YAG laser is quick and relatively painless.

"People come in with tattoos they want removed and we take them off with virtually no scarring," says Arthur K. Balin, MD, a Pennsylvania dermatologist. Tattoo removal requires multiple treatments, he notes. "Sometimes it can take six or eight treatments to get rid of a tattoo.  You can lighten it up right away, but to get rid of it totally, it takes more treatments." 

Just how does a laser get rid of tattoos? "The laser takes all of the energy you'd find in the entire city of Wilmington and flashes it in a billionth of second onto a small area of the skin," says Balin.  This energy fragments the tattoo ink into thousands of little particles.  At this point, Dr. Balin explains, "the body's white cells can come in and gobble them up and get rid of them.  That's why it doesn't leave any mark on the skin; you're actually relying on the body itself to clear the tattoo."

Another very popular use for lasers is to remove unwanted body hair. For Cheryl Leonard (not her real name), an Atlanta attorney, having a laser procedure done by Dr. Walia to remove hair in her bikini area has made going to the beach seem more like, well, a day at the beach.

"It was something I had been thinking about doing for a while, and I liked Dr. Walia very much--it's not the most relaxing issue, you know.  She was someone I trusted, so I went ahead and did it," Leonard says. While she's very happy with the results, she realizes that they may not be permanent. "What Dr. Walia told me was that there's a 50 to 90 percent chance that the removal will be permanent, but that it could come back in years to come. And then the hair that would grow back there would be finer, like the hair on the top of your head," she says.

Leonard underwent three treatments, which, she says, weren't painful. "It feels like a little rubber band popping, but it wasn't unpleasant or uncomfortable. After the last one, they increased the amount of the heat so there was a little bit of burning.  It wasn't like you put your hand on the oven; it was just redder," she notes. "The procedure lasted five minutes,"  she adds. "I didn't know what I was getting into. I was just very pleasantly surprised."

The total cost for the removal was $1,000, but this figure can vary from state to state. Still, Leonard considers it money well spent. "I'd usually have two or three waxings in the summer, at a cost of $40 each, and they would only last about three days per treatment."

Open wide and say "laser"

It's a vicious cycle--you're so afraid of the dentist that you avoid going for years, and then you develop periodontal disease, which forces you to either face that dental chair or face losing your teeth. However, the laser procedures now available will make those of you who think "painless dentistry" is an oxymoron think again.

"The biggest reason people don't go to the dentist is fear," notes George Burbach, DDS, of Chico, California, who has been using a laser in his practice for 10 years and says that it doesn't hurt a bit. "I have never had a patient turn down [the laser procedure]. They're not afraid of it.  The fact is that at least in the early stages of gum disease [using the laser] causes little or no discomfort," he says.  More importantly, Dr. Burbach adds, the laser causes no postoperative pain.

Dr. Burbach uses an Nd:YAG laser for the procedure. "We use the laser to clean out the infected pocket areas around the teeth. We're able to very carefully clean out or peel out the diseased tissue without really damaging the healthy tissue underneath," he says. "In that same process, the laser light is absorbed by the bacteria that is dwelling in the tissues, and it pretty well kills the bacteria and detoxifies the chemicals that are down in the pocket." 

"By another special adjustment of the laser, we're able to go back in after the hard part of the tooth. The root is cleaned thoroughly. Then the laser allows us to provide an ideal clot that seals the pocket.  In other words, it forms a healthy clot in the pocket and that ends up creating ideal conditions for healing . . .  so the pockets heal very well, and we can get a repair in there that's been very difficult to get by standard mechanical techniques and chemicals," he says.

According to Burbach, by healing the pockets to the point where the gums become healthy again, patients can keep their mouths healthy from then on, as long as they cooperate with the dentist or hygienist. And that means no more hiding from the dental chair.

In the eye of the beholder

It took only 10 minutes to make Scott Kirsch's life a whole lot easier. The Cleveland letter carrier spent that time undergoing a LASIK procedure that improved his vision to slightly over 20/20, allowed him to toss out his saline solution once and for all, and enabled him to see his alarm clock in the middle of the night without fumbling for his glasses.

While these may be minor stitches in the overall canvas of life, they're important enough to have compelled millions of people to undergo laser vision correction surgery.

In the procedure, an instrument called a microkeratome creates and cuts a corneal flap, which acts as a hinge. The flap is folded back and the laser then reshapes the cornea below the flap. The flap is then closed, adhering naturally and requiring no stitches.

Surgeons like LASIK because it decreases procedural risks and reduces recovery time, requires no stitches, and only takes between 10 and 15 minutes to perform.  

Patients report very little postoperative discomfort or pain, and what pain there may be usually dissipates in a few hours. Vision returns rapidly, and, 80 to 90% of the time, is completely back by the next day. "My appointment was on a Wednesday, and I drove back home the next day," Kirsch says.

Complications from the procedure occur in 1 or 2 percent of patients and can include under-or over-correction, astigmatism, infection, night vision difficulties, delayed healing, and corneal haze. Kirsch experienced "starbursting" and halos after the surgery, but it dissipated after two months. "I'd see a stop light with a halo around it. But I don't see that anymore," he says. "I would definitely do it again," he adds.

Both costly and priceless

Laser surgery is usually an elective procedure and is therefore typically not covered by insurance. Like any other surgery, it has its risks, and at a range of $350 to $5,000 per procedure, it's not cheap. But, as evidenced in the cases above, sometimes you just can't put a price on quality of life.