The Incredible Laser

When Albert Einstein, a man better known for his grasp of physics than his aesthetic sense, theorized back in 1917 about the process that makes lasers possible, we can be sure he wasn’t thinking how they could be used to improve eyesight, zap frown lines or vaporize away a few extra pounds. Today, though, lasers are a common medical and cosmetic tool that can take years off a patient’s appearance and give 20-20 vision to those who never had it before.

The best vision possible

New York ophthalmologist Steven Trokel performed the first laser eye surgery in 1987. At first the procedure, called Lasik, could only correct the most common types of nearsightedness, but thanks to recent advances, Lasik can now remedy farsightedness and even astigmatism. The latest techniques, used in a procedure called IntraLasik, are more precise and hence less risky than ever, enticing previously wary patients to sign up.

Marin ophthalmologist and Ross resident Gayle Shimokaji finally decided to have laser eye surgery two years ago after waiting for experts to perfect the technique. Shimokaji, an Ironman triathlon participant, wanted relief from the burden of wearing glasses during competition. She consulted Ella Faktorovich (photo at left), M.D., Director of the Pacific Vision Institute in San Francisco. Faktorovich, an ophthalmologist on the faculty of the department of ophthalmology at the UCSF VA Medical Center, is one of the first local doctors to offer IntraLasik.

IntraLasik uses all-laser technology rather than incorporating a traditional surgical blade into the laser operation. In standard Lasik surgery, Faktorovich explains, doctors push a blade across the eye to create a thin flap that is folded back so the laser can go to work. With IntraLasik, doctors create the flap with the laser, which has proven more accurate than the blade. When patients visit her office, Faktorovich says, they’re looking to make their lives easier, and “glasses are the first to go.” The average fee ranges from $2,850 to $3,650 per eye.



Advances for the Skin

Laser technology for resurfacing aging skin was discovered almost by accident: doctors treating acne scars by laser noticed that small wrinkles adjacent to the treated spots were also becoming less visible as a result. According to Peter Hilger, M.D., president of the American Academy of Facial Plastic and Reconstructive Surgery, laser resurfacing is an appealing option because “it treats fine wrinkles and pigmentary irregularities, and these are aging changes not addressed by face-lifts or blepharoplasty [also known as eyelid surgery].”

As the boomer generation ages, the demand for the procedure has risen. Laser resurfacing was one of the top three fastest-growing categories of cosmetic procedures from 2002 to 2006, according to the American Academy of Cosmetic Surgery. This popular procedure doesn’t come cheap: a full-face Fraxel laser treatment in Marin can cost $1,000 per visit.

Several types of laser resurfacing techniques exist, each with different results and projected recovery times. Fraxel appeals to people who want sigificant results but have limited time to take off for healing. This type of laser passes through the outer skin surface, targeting the layer underneath.

“Imagine your skin is a digital picture made up of thousands of spots,” says Laser Center of Marin Medical Director Susan Martling, M.D. “The Fraxel laser treatment is able to target single skin cells by using microscopic laser columns that are smaller than the width of a hair. The precise treatment eliminates old, damaged surface cells and penetrates deep into the inner layers of the skin to initiate and encourage the body’s own natural healing process. As healing begins, the damaged skin is replaced with fresh, healthy skin and new collagen is formed deep in the subsurface layers.” Fraxel is best, Martling says, for improving texture, tone and pore size or correcting melasma (hyperpigmentation), crow’s-feet or general sun damage.

For more extensive skin repair, a CO2 laser may be the right option, says Diana Parnell, M.D., a board-certified dermatologist at the Cosmetic and Laser Surgery Institute in Greenbrae. Before-and-after photos of her patients show them appearing decades younger after the procedure. Parnell says a CO2 laser emits a beam that removes the top layers of skin. During the healing process, new collagen is produced, making the skin tighter and smoother. Side effects like redness that can last up to three months (or in some cases longer) are more pronounced with this laser, but the results are more noticeable.

People who can’t afford that much down time but want to look “five or 10 years younger may want to try the ActiveFX,” says Parnell. This laser stimulates new collagen growth with just one pass of the beam, for a more superficial resurfacing.





Beaming Ahead

Future laser potential will be endless if Scott Davison has his way. Davison is president of Raydiance, Inc., a Petaluma start-up developing an ultrashort pulse (or USP) laser that could have myriad medical and cosmetic uses. “The difference between this laser and all the lasers that have come before it is [it produces] a fundamentally different interaction between light and matter,” says Davison. “There is so much power in each pulse that it disrupts atomic structures.”

Whereas other types of lasers remove matter by heating the molecules, he explains, the USP laser vaporizes matter by more fundamentally disrupting the molecular structure. “The pulses are so short, there is no heat involved.”

And that means it could be used, for example, to remove tattoos without burning the skin or to kill cancer cells without hurting healthy ones. Other possible applications include liposuction, mole and wrinkle removal, and eye surgery.

Since the laser can be activated at different depths, “I can focus it below the skin, so for liposuction it would be focused into the fat layer, instantly vaporizing fat,” says Davison. “You wouldn’t have to suction [fat] out of the body; if you vaporize the fat molecules, [they] will be absorbed by the body.” It will be a few years yet before the USP laser might be okayed for this type of use, though approval for cosmetic procedures could come as early as next year.

The technology for the USP laser has existed for more than 20 years, says Davison, but his company has miniaturized it, making it more commercially viable. “It can target, analyze, detect,” he says. “The laser will look at the target, decide what’s wrong and fix it. We see it as one of the biggest breakthroughs in 40 years.”





Cosmetic and Laser Surgery Institute (Greenbrae)
Diana Parnell, M.D.
Board-certified dermatologist

Laser Center of Marin (Corte Madera)
Susan Martling, M.D.
Family practitioner and director

Miguel Delgado, M.D. (Novato)
Board-certified plastic surgeon