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Cosmetic & Aesthetic Lasers: A Look into the Future

Lasers have revolutionized medicine in the last 30 years and continue to play an integral role in treatment. What is the future for medical laser development?

Dr. Rox Anderson
Dr. Rox Anderson

American Health and Beauty recently attended the annual meeting of the American Society for Laser Medicine and Surgery (ASLMS) where we had the honor of speaking to society president, Dr. Rox Anderson. Dr. Anderson has been an important driving force in the use of lasers for skin treatments and is often hailed as the father of fractional resurfacing.

"I'm sort of a problem solver really. Along the way we have in fact not invented but directed the development of lasers specifically for medical uses," says Dr. Anderson. He says it started with a desire to treat newborns with birthmarks and he worked in conjunction with John Parrish to find a treatment that didn't cause scarring. "We ended up using a pulsed dye laser which was very selective and it was the first time that a laser was made specifically for a medical application, and it was also the first time that the combination of absorption and pulsing was used to very selectively affect a microscopic target, so you can damage something without hurting the whole neighborhood."
laser medicine

Dr. Anderson went on to use the lasers for other functions such as tattoo removal and pigmented lesions. Over the years the work has evolved so that "lasers are really the mainstay for treating some of the skin disorders." Lasers have found function outside of skin problems to also treat cosmetic issues and Dr. Anderson's laboratory helped develop the first permanent laser treatment for hair removal. "We figured out how to control the pulses so that the stem cells that are responsible for making the hair cycle and grow could be injured, and by removing those stem cells, somewhat selectively, you can have permanent hair removal. That's now the number one use of a laser."

One of the critical benefits that lasers offer is their selectivity. You want to treat only the condition at hand without harming the whole. "The old versions of surgery are often a wrecking ball - too destructive. It turns out that almost every tissue in your body is able to heal without scarring as long as the surgery is done on a microscopic scale."

Dr. Anderson is impressed by recent advances from physicians like Dr. Jill Waibel who is making strides in treating burn victims. Further, the use of lasers for body contouring is of great interest. "When i was in med school i was taught that all of the fat cells in your body, you were born with them and you'll die with them, they never change, they might get bigger and smaller and it was viewed as just excess, baggage tissue. All of those are completely wrong, it's a living endocrine system it's got wonderful controls around it and you can affect those in very many ways, so we figured out how to selectively damage and remove fat, and I'm quite interested in doing that, not just in the skin but everywhere throughout the body."

Zeltiq is a new treatment for fat that uses cold therapy to damage the fat cells. Dr. Anderson was one of the physicians working on this treatment's development "there's a very rare condition where newborn children who are accidentally exposed to cold will suffer injury, and what's interesting is only the fat will die and regress. The kid's are fine, but you end up with skinny kids in the area that's been contacted with cold and we got very curious, once I started thinking about fat, well what is that, how does it work? and is it only in babies or can you make it work in adults? It turns out that we understand the process now. The fat will crystallize, the best analogy is a stick of butter that has a lot of fat in it. If you leave it out at room temperature for a while, it spreads easily and you can easily butter your toast with it, but when you first get it out of the refrigerator, it's pretty solid. When you look at, let's say the milk in your refrigerator, it doesn't do that. What's going on with a stick of butter is that the fat molecules crystallize, they 'freeze' if you will at a much higher temperature than water does. In your body, fat is by far the richest lipid tissue and it undergoes the same transition."

"More and more these days, we have the ability to theoretically create new scenarios. Light activated drugs can be designed, nanoparticles can be designed to interact with light or act as probes." Dr. Anderson goes on to say that a large part of the future for lasers will be in diagnostics. "Very little of that has made it's way into medicine yet. Most of what we were talking about before was treating people with lasers, but seeing inside the body and getting a real good view of what's in there, is reaching that kind of tipping point where it's ready to go. I envision, for example, we're already able to see the best views ever of coronary artery disease.... The cardiologists who are trying to take care of people with the number one killer in America, have never been able to see what they're doing really well, so I think lasers are going to play a huge role in that, and they're already starting to do so."

Also, he says we'll likely be using lasers for both treatment and diagnosis. Rather than taking a tissue sample in one surgery and sending it to a lab for comparison, he foresees being able to do both in one procedure. "It's so much more appealing to do the microscopic imaging as a way of guiding the surgery to begin with, and do that whole thing with lasers. I know it sounds a little fanciful, but almost all of the technology to do that is actually sitting on the shelf right now.... We have, I think, an unprecedented opportunity, and we also have a responsibility to do it."