As early as 1917, Einstein predicted the existence of stimulated radiation and the possibility of light amplification, and then established the basic theory of lasers. In 1954, Cordon JP and Townes CH made a stimulated emission optical amplifier based on Einstein's theory. In 1960, Maiman made the world's first laser, the ruby laser. From then on, a completely novel light source was born. . With the rapid development of research on the biological mechanism of laser action and the development of laser medical equipment, the application of lasers in plastic and cosmetic surgery is becoming more and more widespread. So far, the development of laser aesthetic medicine can be roughly divided into the following five stages:
Most of the basic theoretical research on laser cosmetic medicine was completed in the 1960s. Since the advent of the first laser, Goldmanl and others, known as the "founder of laser medicine", have begun to study the interaction between laser and biological tissue on the skin; in 1961, someone tried using ruby laser to weld detached retinas; In 1963, Goldmanl began to apply ruby laser to benign skin lesions and tattoo treatment with success, pioneering the application of laser medicine. In the mid-to-late 1960s, ion (Ar*) laser, low-power CO2 laser and neodymium glass laser were also developed, but they were not widely used in clinical applications. my country was at the forefront of the world in the early days of laser research. In 1961, the Changchun Institute of Optics and Mechanics developed my country's first ruby laser. In 1965, Beijing Tongren Hospital began animal experiments on ruby laser retinal coagulation. In 1968, Shanghai developed Nd: YAG (Neodymium Yttrium Aluminum Stone) laser.
In 1970, Goldmanl et al. used continuous CO2 laser to treat basal cell carcinoma and skin hemangioma for the first time. By continuously providing effective laser power and energy density, they overcame the shortcomings of low power and low efficiency of early pulse lasers, thus setting off the first laser treatment at home and abroad. Laser medical treatment boom, continuous C02 laser is widely used in surgery, dermatology, ENT, gynecology, physical therapy, acupuncture and oncology, etc., and has achieved satisfactory results. Continuous lasers used in skin beauty in the 1970s also included Ar*, Cu vapor and Nd:YAG lasers. These continuous lasers are non-selective in their thermal damage to tissues. After treatment, they are often accompanied by adverse reactions such as skin scarring and hypopigmentation, and they still fail to achieve good cosmetic effects.
In 1983, Anderson RR and Parish JA proposed the theory of selective photothermal action - the "photothermal separation" theory, which means to select the appropriate wavelength, energy, and pulse duration based on the biological characteristics of different tissues to ensure the treatment of diseased tissues. This theory achieves the perfect unification of laser effectiveness and safety while performing effective treatment while trying to avoid damage to surrounding normal tissues. It is a public and external milestone in the development history of laser medicine, especially laser cosmetic medicine.
Pulse laser machines designed based on selective photothermal effects made great progress in the 1980s. Erbium lasers, excimer lasers, and constantly improving CO2 lasers and pulsed dye lasers have appeared one after another. New laser technologies have been relatively maturely used in research, diagnosis and treatment of diseases, and cosmetic treatments, and a large professional team has been formed. It is one of the important symbols of the formation of laser medicine discipline.
Since the 1990s, with the advancement of science and the development of laser technology, medical lasers have been continuously combined with new technologies such as electronic computers, fiber endoscopy, image analysis, camera video, fluorescence spectroscopy, X-rays and ultrasound, making medical lasers Developing in the direction of high performance, intelligence, miniaturization and specialization. New beauty laser machines are springing up like mushrooms after a rain and have made very significant achievements.
In the early 1990s, the application of Q-switched laser to treat pigmentary diseases such as Ota and tattoos has achieved almost perfect therapeutic effects; in the mid-to-late 1990s, variable pulse width and frequency-doubled lasers have also achieved good results in the treatment of vascular diseases. ;At the same time, the emergence of long-pulse ruby laser, alexandrite laser, Nd:YAG laser and semiconductor laser has also made laser hair removal technology increasingly mature; in addition, the advent of high-energy super-pulse CO2 laser and erbium laser has made laser hair removal wrinkle removal Popular in Western countries (due to pigmentation problems, this technology has not been widely deployed in yellow people), and recently there have been some non-destructive laser wrinkle removal systems, such as CoolTouch, SmootBeam and Nlite, etc.
The postoperative reaction after application of these instruments is mild, and certain clinical effects can be achieved. In the late 1990s, intense pulsed light (IPL) technology emerged and became popular all over the world because it can improve photoaging changes. In the early 1990s, laser beauty technology gradually developed in some big cities in my country. By the mid-to-late 1990s, advanced complete sets of laser beauty instruments from the United States, Israel, the United Kingdom, Germany and Japan quickly poured into our country and became popular. Some domestically produced Laser beauty instruments have also been increasingly used in China. Laser beauty occupies a unique place in the entire laser treatment, and its prospects are constantly promising. Modern laser cosmetology has become the most attractive and promising part of contemporary medical cosmetology.
This period is mainly characterized by standardizing the clinical application of lasers and proposing standard treatment parameters for cosmetic lasers, as well as the emergence of new equipment and the development of new treatment projects. The latter mainly refers to the proposal of the theory of fractional photothermal effect, the emergence and clinical application of fractional laser and photoelectric synergy equipment, the continuous improvement of intense pulsed light and radio frequency equipment, and the clinical trial of plasma skin regeneration technology.
The biggest development at this stage is in skin reconstruction such as laser rejuvenation and wrinkle removal. In particular, in order to balance the objective effects of exfoliative wrinkle removal with the rapid recovery and safety of non-exfoliative wrinkle removal, research on laser skin reconstruction in recent years has And the development direction is relatively concentrated on radio frequency (RF) technology, fractional laser (or image beam laser) technology and plasma skin regeneration technology. E-light (a combination of light energy and radio frequency), fractional laser, and plasma skin regeneration have emerged. Technology and other new equipment have good clinical results.
The first is the application of radiofrequency technology in cosmetic surgery. Although the US FDA approved RF technology for cosmetic use in March 1999, the first set of cases of RF wrinkle removal and facial rejuvenation were reported in 2002. RF is a high-frequency alternating electromagnetic wave. The charged particles in the skin and subcutaneous tissue oscillate and rub under the action of electromagnetic waves to generate heat. When reaching a certain temperature, the dermal collagen fibers will immediately shrink and denature, and then continue to The principle of collagen regeneration and remodeling is similar to that of non-ablative wrinkle removal. Due to satisfactory efficacy and few adverse reactions, RF technology has been successively approved for improving wrinkles and sagging of periorbital, full face and body skin. Since then, RF technology has been combined with IPL or laser technology, called E-light technology, which takes advantage of both radio frequency (electric energy) and phototherapy (light energy) to enhance the efficacy of RF and reduce the complications of laser or IPL. .
Followed by the emergence and rapid development of fractional laser technology. In 2003, the theory of fractional photothermal effect, also known as localized photothermal effect and pixel photothermal effect, was proposed. In 2004, a large number of non-ablative fractional lasers began to appear one after another, and in 2006, ablative fractional lasers also came out one after another. The vigorous development and widespread clinical application of fractional lasers have shown good therapeutic effects. In view of the objective effect of fractional laser on facial rejuvenation, especially in improving skin texture, and its safety in clinical application in people of all skin colors, some people in China have proposed it as the first-line treatment method for laser wrinkle removal.
Plasma skin regeneration technology is a new treatment mode developed by inheriting the excellent effects of ablative laser wrinkle removal while overcoming the shortcomings of trauma and complications. It is essentially a minimally invasive ablative treatment PSR that can be precisely controlled. The mechanism is to excite nitrogen with an electric field generated by ultra-high RF, obtain energy after vibration, decompose into singlet nitrogen, and finally ionize into a plasma state. After decay, special yellow light is released, and its energy directly acts on the skin for treatment. After the skin is rapidly heated, the necrotic epidermis is completely attached like a biological dressing, which is conducive to the rapid regeneration and collagen formation of the epidermis and stratum corneum. This treatment method is suitable for improving loose pigmentation, wrinkles, acne scars, and old epilepsy marks on the skin of the face, neck, chest, and hands. The treatment is less painful, the recovery is faster, and the postoperative complications are less. However, there are currently very few reports and experiences of Asians using this treatment method.
Judging from the development history of laser cosmetic medicine, laser cosmetic medicine has gradually developed and improved in the direction of significant curative effects and fewer complications. This is mainly reflected in the continuous deepening and expansion of theoretical research on laser cosmetic medicine, as well as new high efficiency and high safety. The development and launch of sexual equipment. But even today, with the rapid development of laser cosmetic medicine, various complications and adverse reactions of varying degrees still often occur clinically, such as pigment changes (hypopigmentation or hyperpigmentation), scar formation, infection, and blisters. Formation, purpura, crusting, pain, and some relatively rare complications. I believe that with the continuous development of laser technology, these clinical problems will be gradually solved.
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