Q switch laser. Why are you NOT getting results?

The Q switch laser is widely used by many doctors for many various reasons. Some doctors use them for acne, some for pigmentation while others use them for pores. Yet on numerous occasions, I get patients who tell me that they had done similar lasers and NOT see any results.  Yet they are somehow able to see a difference when the Q switch laser is performed by others. So what's the difference?
Why are some doctors able to get the desired eradication of pigments and even skin tone while others are unable to do so? What's the real secret?

The Q switch laser is essentially an ND-YAG laser. Being a ND-YAG laser, this means that the clinician has chosen the 1064nm wavelength to treat your skin. The choice of wavelength is dictated by the need for good absorption of the laser or light energy in the target structures deep in the skin, while avoiding unnecessary damage to the epidermis or the top most layer of the skin. For the treatment to be effective, the light energy needs to penetrate deeply into the skin because it is necessary to destroy or thermally affect specific skin structures. Depending on the location of the pigment or the end target in the body, the light energy must penetrate to at least 2-7mm in the skin to be effective.

This is dependent on 2 main properties of the laser. The absorption and the scattering of light.
Absorption of the light energy is dependent on numerous factors like the depth, absorption coefficient and intensity of the laser beam.

The absorption coefficient in real skin also vary from the absorption coefficient isolation. Chromophores do have very specific and selective absorption coefficient yet in real skin, this is influenced by numerous other factors. An example of one of this factors is skin colour. Skin colour affects the melanin concentration and this increase in darker individuals. This consequently results in greater penetration depth. Hence using a non Q-switch ND Yag laser results in increase thermal injury.

Scattering is yet another factor that affects the end result of treatments. Scattering of the laser light substantially influences the beam propagation through tissue and thus affects energy absorption in the skin. Once light penetrates through the skin, the depth of penetration becomes strongly influenced by scattering. The degree of laser light scatter before reaching the target is also dependent on the laser wavelength. It is important to know which laser is being used as this influences the amount the scatter. An example would be, when comparing the Q-switch laser to say an IPL or a ruby laser, a ruby laser would require a larger spot size and energy. This is the same if you are comparing an alexandrite laser to a diode laser.

With scattering, light no longer travels in a straight line. Its direction becomes random and causes the light to bounce back and forth inside the skin until it is absorbed. In order to penetrate deeply and unidirectionally, the wavelength and large spot size is important. The influence of spot size on the penetration depth and the energies require to achieve this is highly dependent on the machine and the experience of the doctor. Every single Q-switch laser in the market has a fixed spot size with a maximum energy and frequency it can be fired yet. So, not all Q-switch are equal! Some are indeed better than others. Each of these factors greatly influence the ability of your doctor to achieve the results you desire. With numerous lasers out there in the market, eg the IPL, Ruby laser, Erbium, Co2 etc etc etc... patients in the end really do need to trust the doctor they are seeing.

Pulse width, ... yet another factor I haven't even begun talking about. But by now, I am certain anyone reading up to this last paragraph is already already confused. And if you are a doctor reading my blog, at least I hope you gained some information reading on the 2 factors mentioned above. Absorption and scattering. Period.

Till then, treatment intervals, fluence and shot count.. more technical terms... keep it coming!

Adult acne - Permanent Results. Proven.

It's been a very long time since I've updated this blog. But I thought this was time I release an update on the treatment outcomes and methods that is used to treat Adult Acne.

Its great to see lovely outcomes from my patients with the clearance of their acne and the lack of recurrence especially with the use of the AGNES treatment.

AGNES was previously only exclusively available to my clinic but now I can see it being used widely in Singapore. This is good news as the local distributors have decided to sell his machine now to many other clinics.

AGNES is a treatment used to selectively destroy acne prone oil glands. It is quite common for one to then wonder, if doing AGNES will make the skin less oily or will it make it dry and wrinkled. This will not happen, as only very few oil glands are destroyed in proportion to the millions of oil glands located throughout the entire face. On the contrary, it is very likely that topical creams are the most likely cause of the dry skin. However, even through this is uncomfortable and make up often does not sit well on a extremely dry texture, the side effect is nevertheless temporary.

Why is it that sometimes the performance of AGNES varies? AGNES is a very specialized procedure. Accurate identification of the oil glands including direction of the oil glands and accurate selection of the energy required and number of shots needed for complete oil gland destruction takes experience and patience.

Is AGNES a miracle treatment in the treatment of acne and pimples? There are no miracles in treatment of this extremely difficult condition. Yet improvements in medical technology continuously pushes the boundary and allows us doctors to continuously do our best for our patients.

Acne has indeed multi causes. From hormones to genetics to the environment. Every doctor has their own way of treating acne. It is a constant battle to improve our methods and improve our techniques with research taking place regularly on how best to treat this.

I personally do not perform AGNES on all my patients either. Selection of the right candidate for the best outcomes depends on the expertise of your doctor. And again as mentioned, acne alone because has multiple causes, one really needs detailed and careful evaluation as to the likely cause of the pimple before knowing which treatment would work best.

Lastly, acne also has many different forms. Some are huge giant cystic nodules. Others may come as smaller papules or tiny red bumps. While others may appear primarily as bumps on the skin or commedonal acne. Some people describe their acne as fungal acne when it is really pityrosporum folliculitis. And then combined with Rocasea there is subtype 2 Rocasea with papularpustular rocasea or pimples associated with redness and flushing of the skin.

The diagnosis of acne is often straight forward yet it is really up to your doctor to identify the cause and treat it accordingly.