Intense Pulsed Light (IPL) was developed in the 1980’s for the treatment of photo-damaged skin. Unlike laser devices that use a single wavelength of light, IPL uses a xenon flashlamp to generate intense pulses of broadband light at very high energy. Filters are used in the IPL device to restrict the actual wavelengths that are emitted. Thus, various IPL’s have been developed with a range of filters depending on the application that the machine is used for. For instance, a filter that lets out light of a shorter wavelength would be expected to treat melanin in sunspots, while a longer wavelength filter would let through light that would tend to heat collagen and penetrate more deeply to stimulate collagen remodeling.
IPL has gained great popularity through its application for the “photofacial.” This is generally a quick and relatively painless office procedure. Patients with sun damage in the form of sun spots / age spots, abnormal redness and sallow skin tone stand to benefit the most from the treatment. Additionally there are benefits for superficial wrinkles and other textural problems. Unlike lasers that are used for skin resurfacing, such as the CO2 laser, IPL is better tolerated and has fewer side effects. Typically it is administered as a series of 4-6 treatments with incremental results from each visit. Common side effects include redness and roughness of the skin that may last up to a week. Contrast this with treatments by lasers used for resurfacing, such as the CO2, that can leave denuded skin that requires prolonged healing and carry a higher risk of scarring.
As with other lasers that target melanin, darker-skinned patients are not good candidates for IPL. The increased baseline melanin in darker skin creates a stronger background target for the light and increases the risk of a burn. If the skin is too dark, then the therapeutic window may be too narrow to expect good results. An ideal candidate is one who is fair-skinned but who has significant photodamage, usually from years of sun exposure.
More recently, a novel approach to facial rejuvenation has arisen that combines light sources, such as IPL, with photosensitizers that increase the effect of the light. This is termed photodynamic therapy. The most commonly available photosensitizer in the US is 5-amino levulinic acid (5-ALA). 5-ALA was previously described with the use of a light source for treatment of actinic keratoses on the face. Subsequently, it was shown that 5-ALA could be combined with IPL to increase the effectiveness of photorejuvenation. This showed significantly increased benefit for fine lines and pigmentation.
5-ALA is applied to the skin for at least 30 minutes prior to the procedure and allowed to soak in. After treatment with IPL, the patient may experience more redness and scaling than with IPL alone. Furthermore, strict sun avoidance and protection is required for 48 hours since the 5-ALA remains within the skin and can increase redness and discomfort if the skin is exposed to sunlight. Also, commercially available 5-ALA, marketed as Levulan Kerastick, costs approximately $100 per application. On the other hand, the increased effectiveness of photodynamic therapy makes the addition of 5-ALA an attractive option.
Further research is constantly being pursued in this popular area of laser and light source technology. Already, companies have combined additional technologies with IPL. Syneron, for instance, has added bipolar radiofrequency with the idea of enhancing the IPL’s effect. Aesthera, has combined suction with broad-band light to increase effectiveness. Watch for future developments in this exciting arena.
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