Understanding Lasers, Radiofrequency, IPL and Other Energy Based Devices

Lasers are devices that use light as an energy source to change the skin. Examples are hair removal lasers (our GentleLase), tattoo removal lasers (our RevLite) and lasers for remodeling the skin by removing the surface (resurfacing lasers such as Fraxel, CO2 resurfacing {CO2RE} and eMatrix).
See figure 1 below.


Figure 1 – Different laser depth and wavelength in a cartoon of a cross section of skin. Visible light lasers use blue, green, yellow and red light. Deeper lasers use infrared light (not visible) to create heat in a very specific target.

With the advent of new technology, we now refer to all of our equipment as “energy-based devices.”
Intense Pulsed Light  See figure 2 (below).

Figure 2 – A blend of visible and infrared light in one pulse to generally rejuvenate the skin gently after multiple treatments.


The difference between intense pulsed light (IPL) and laser is that laser uses only one wavelength whereas IPL has a range of light wavelengths. Lasers are much more specific for one target, whereas IPL has a range of targets. Let’s say we had a brown spot we wanted to treat (also known as a sun freckle, lentigo or age spot). We have a laser that has one specific wavelength of light that just targets melanin, which is what a brown spot is made of. So it is a specializing laser, and is extremely effective for that one thing, but it doesn’t have many other uses. For instance, if we have someone who has brown spots but also has dilated blood vessels on the face as a result of sun damage or from having rosacea in addition to sun damage, then we would need to use 2 different lasers to treat those two different things. We could add a laser that is focused on red spots called the Vbeam® to the laser that is focused on the brown called the Q-switched.

Since there are a lot of people with both brown and red spots, someone got the smart idea of using IPL, or a blend of different wavelengths. This allows us to treat both red and brown at the same time. However, because it is kind of a jack-of-all-trades, it isn’t as effective in one single treatment for each of these things as the lasers are. So we typically do a series of treatments over a few months, because over time the results from this adds up to the results we might get with the other devices if we used them separately. Another bonus to treating the entire skin surface with light, as opposed to just treating certain spots, is that we also get improvement in wrinkles, pores and all the in between tones that exist (ie not yet formed brown spots and red that are still there nonetheless and will be coming out soon).

The lack of downtime and overall effectiveness of this treatment makes it extraordinarily popular, and it has been a mainstay of esthetic treatments for about 15 years.

Radiofrequency is not based on light, but is based on electricity. An energy is developed that has a positive and negative pole and the heat generated is due to the resistance of the skin as the energy travels through it. This can cause general “bulk” heating in the case of Thermage®, where the heating causes the cells that make new collagen to be very active as well as change the way the collagen sits in the skin in an advantageous way that makes the skin firmer or tighter. We can also use radiofrequency to resurface the skin, like we do in eMatrix, by using many tiny electrodes (positive and negative poles) to cause heating just under the skin surface which is great for wrinkles, scars and pores.

The advantage of radiofrequency is that it is “color-blind” so that it doesn’t matter if you are tan or have a dark color of skin, it doesn’t specifically heat up melanin, thus removing a big potential cause of side effects from laser (too much heating of the skin, which can be different for different people and even different parts of an individuals face or body can cause hyperpigmentation or darkening of the skin).


Most recently we have introduced a new energy source, that of cold. CoolSculpting® removes heat from the fat causing many of the cells to slowly die and be reabsorbed by the body. This takes advantage of the fact that fat gets colder than skin, so we can selectively damage the fat without damaging the skin.

Finally, another new energy modality is ultrasound. Mainly known for being a diagnostic test that can see the difference under the skin between things that are solid or cystic or can see veins and arteries flow, ultrasound energy is used as the basis for Ultherapy®, another lifting and tightening device for the face and neck.

The Ultherapy® uses sound waves to find the proper plane of treatment in the skin and then can deliver a focused beam of sound to a very exact spot in the skin to cause an invisible wound that makes the skin around it metabolize faster and develop more collagen and elastic tissue around it. We can focus Ulthera® on 3 different depths of the skin very precisely, and make multiple tiny unseen wounds that cause a massive amount of new collagen to be built by our own bodies, resulting in a lifting of the skin and a smoothing out of creases, wrinkles and folds of the neck, jowls, cheeks and forehead.

Energy based devices have gotten safer and more effective over the years much like other technology in our lives. At Advanced Dermatology we have many different devices because each has some very great advantages but also some disadvantages. Unlike being a carpenter with only one hammer, where everything looks like a nail, we have many sophisticated devices so that we can tailor them to what your needs and exact skin type and goals are.