IPL- is it good?
Author: Magdalena Atta-Motte
IPL in aesthetic treatments
What to choose and why? This is probably a common question asked before buying a device for the practice. It may seem that it ‘s all the same, but not in this article I will present you the application of IPL in selected issues that you encounter in your practice every day.
We know well that IPL as polychromatic light is widely used in cosmetology. We know that most of the scientific studies have shown a similar effectiveness of the use of IPL compared to lasers. However, due to the polychromatic nature of light, it may also have a greater risk of thermal tissue damage when IPL is used without good clinical experience.
When choosing an IPL, it is worth paying attention to a few details. Good device:
– Has replaceable filters in one handpiece, Uses so-called filters. Cut-off and the so-called double filters,
Replaceable filters in one head are a great convenience during treatments, then there is no need to switch different handpieces.
Cut-off filters are the basic working tool when unwanted wavelengths are “cut off” below the one marked on the filter. Double filters additionally ‘cut out’ the light bands in between and are used, for example, in treatments to reduce vascular lesions or to reduce acne.
– It has interchangeable treatment spots and the crystal is sapphire crystal.
The sapphire crystal is an extremely good light conductor, it is additionally very hard, which increases the quality of the device. Various shapes and sizes of these crystals – as treatment spots allow for precise targeting of the treatment area, while ” saving ” the area where we do not want to work – it works great in treatments reducing vascular or pigmentation changes.
– Produces the so-called square pulse.
This is a completely new solution. In addition to the fact that it reduces the pain sensations of customers, it also ensures even distribution of specific wavelengths of light and very well selected energy.
– It has the possibility of sequential pulsing.
This solution is necessary when we need to damage the target chromophore, and we do not want to burn the surrounding tissues. In this way, we have the opportunity to ‘cool down’ between short impulses.
– Has a built-in cooling system,
This is one of the necessary treatment parameters. The lack of which causes unwanted burns to the skin. You should always remember to cool the skin after the procedure, sometimes also before and during the procedure, depending on the procedure.
– Has the ability to independently correlate basic treatment parameters,
For more treatment freedom and achieving the best results.
– Has an intuitive software system,
Here it seems reasonable to start with ‘the dawn of time’, that is, from the introduction of the concept of selective photothermolysis in the 1980s by Anderson and Parish.
Based on this theory, we are able to perfectly match the duration of the pulse depending on the volume of the target chromophore and its thermal relaxation time (TRT) and correlate it with the fluency used.
The wavelength is the key, therefore the depth of light penetration depends on this value to obtain the expected damage to the target chromophore, such as: melanin, hemoglobin or water.
This theory started the stories of photo epilation and subsequent treatments using the photo-thermal effect on the skin.
Another thing to keep in mind is that in the late 1990s, the US Food and Drug Administration (FDA) approved the first ruby laser with hair reduction indication.
In 1990, high-intensity flash was described for the first time as a new tool for the treatment of vascular lesions; the first IPL medical device for benign vascular lesions was introduced to the market in 1994.
Photoepilation as a treatment is undoubtedly one of the most frequently performed procedures.
Here, the target chromophore is melanin in the hair bulb and papilla.
The hair bulb and the embryonic matrix are rich in amelanotic stem cells, which are most effectively targeted during the anagen phase of the hair growth cycle, when the unpigmented embryonic matrix is closest to the pigmented structures. ,
IPL and the laser devices used in these treatments emit wavelengths in red or near infrared, which have a chance to reach just this deep. So, both lasers and IPL work exactly the same way to destroy the hair root.
As for the ethnicity of the clients who respond best to the use of IPL in hair reduction treatments, they will be those of the Caucasian phenotype, i.e. people with fair skin and dark hair.
You can often meet with IPL criticism regarding the feelings of clients during the procedure. Here it is worth asking about the type of pulse shape It is worth mentioning that currently on the market there are IPL devices with a calibrated or square pulse shape, which allows almost all emitted energy to be concentrated at very specific wavelengths.
Since those years, many features of the first-generation IPL devices have undergone technological improvements, with particular emphasis on the xenon-discharge flash and electronic control of capacitor banks. These capacitors store and discharge electrical energy, which generates high-intensity, pulsating, polychromatic light. Computer-aided selection of treatment settings is also systematically improved, and the filters used have been developed to absorb most of the infrared radiation.
This allows you to reduce unwanted pain sensations and increase the effectiveness of treatments
The described scientific studies comparing diode lasers with calibrated IPL show that the square shape technology used allows to avoid unwanted pain sensations with similar effectiveness of treatments compared to diode lasers.
However, my own experience and research show that the use of IPL with an uncalibrated pulse shape prior to diode laser treatments reduces the effectiveness of the diode laser used afterwards. What is an important tip for you – IPL should be used after.
Observations of photoaging caused by chronic exposure to UV sunlight include wrinkles and rough skin texture, altered pigmentation, and loss of elasticity.
IPLs are a great choice when it comes to photo-rejuvenation, because as a polychromatic light waves they target each of the chromophores we want:
Melanin, haemoglobin, and water.
Even with the first-generation IPL devices, according to studies, there was an improvement in texture and telangiectasia in people with skin types I-IV; the improvement of pigmentation was maintained in 79% of treated patients even 4 years after the procedures.
Regarding the biological mechanisms underlying IPL photorejuvenation, it appears that the structures of the epithelium and skin are preserved for several weeks after IPL treatment with no further changes to sun-damaged skin.
Skin dendritic cells will be a biological target in photorejuvenation of IPL as suggested by the expression of the heat-induced protein hsp70 (70 kilodaltons heat shock protein) and procollagen 1 by these cells as markers of their activation.
Activation of dermal dendritic cells may be the cause that ultimately leads to collagen deposition by skin fibroblasts. Here, photo bio-modulation with light is often used, where long pulses of 2-4 seconds are emitted at low energy.
The cosmetic benefits are not related to damaging pre-existing skin structures. Conversely, it has long been known that increased collagen deposition in the upper papillary and upper reticular dermis and the neater arrangement of elastin fibers play a role in clinical and aesthetic improvement of the skin.
And what else?
It is worth noting that the scope of IPL application is constantly growing.
In addition to photo-epilation and photo-rejuvenation, the comprehensive range of light wavelengths emitted by IPL is applicable to a wide range of treatments, such as:
- Dyschromia, photo damage to the skin, pigmentation changes in the epidermis and skin, solar keratosis and overgrowth of the sebaceous glands;
With regard to the phototherapy of dyschromia, according to the available studies, there is an improvement in dark and light lentil spots and vessels smaller and larger than 0.6 mm with IPL. Treatment times and local pain assessment significantly favored IPL compared to PDL dye laser (mean time of the third session; pulsed dye laser 7.7 minutes, IPL 4.6 minutes, P = 0.005; average pain rating, pulsed dye laser 5.8 minutes , IPL 3.1 minutes, P = 0.007).
In another study with mild pigmentation lesions, 96% of patients with solar lentils and melanocytic nevi had decreased pigmentation with an average clearance of 74.2% and 66.3% of lesions, respectively.
Superficial crusts and ulcerations were observed in most treated lesions, followed by some degree of erythema, but healing was complete within 30 days. ,
Disseminated porokeratoses, presenting as asymptomatic or mildly itchy atrophic plaques surrounded by a hyperkeratotic rim, have also been successfully treated with IPL.
- Common acne, rosacea,
IPL technologies have also long been used in the treatment of acne vulgaris. IPL appears to work by acting on both inflammation and the sebaceous glands, where a photomodulating mechanism is used to stimulate porphyrins to produce O3, which then destroys p.acnes cells. Several IPL treatments reduce the density of inflammatory cell infiltration and the surface of the sebaceous glands, especially in the more inflammatory acne variants, in parallel with the reduction of the Cardiff acne disability index or other factors of the influence of the sebaceous gland.
linear. In addition, selective photo-thermolysis of blood vessels supplying the sebaceous glands may also contribute to the effectiveness of acne inhibition by reducing the rate of sebum secretion.
This photodynamic effect is mediated by the energy absorption of porphyrins produced by Propionibacterium acnes (absorption peaks: 400, 510, 542, 578, 630, 665 nm) to produce bactericidal reactive oxygen species.
All light-based therapies, including IPL, are particularly effective in treating inflammatory acne vulgaris with minimal side effects. As confirmed in a 2016 clinical study comparing the clinical efficacy of 3 IPL sessions on the right side of the face and a 1064 nm Nd: YAG laser on the left side at 4 week intervals in 74 people with mild to severe facial acne.
The reduction of inflammatory papules, pustules, nodules and cysts was similar for both phototherapy strategies (-67.1% and -70.2% with IPL and Nd: YAG laser, respectively).
- Vascular changes, venous malformations, infantile hemangiomas, Civatte poikiloderma, telangiectasias, capillary malformations, angiokeratoma
Vascular skin lesions such as facial telangiectasias and vascular spots are successfully removed with IPL.
IPL can even be considered the first choice, even compared to PDL dye laser. The mechanism of action is related to the selective absorption of IPL energy by hemoglobin in the target blood vessels. ,
In patients with “port wine” spots resistant to multiple pulsed dye laser treatments, almost half of the patients (46.7%) responded to four IPLs. sessions with over 50% reduction of changes.
The mean clearance for responders was 83.9 ± 9.5%. The majority of IPL responders (85.7%) achieved a reduction of 75% to 100% of primary staining; only the changes in the middle part of the V2 facial dermatome did not respond. Preference for IPL over multi-pulse dye lasers was expressed by 93.5% of patients.
- Superficial basal cell carcinoma and Bowen’s disease, Becker nevus.
Most interestingly, the molecular mechanism of such a potent anti-inflammatory effect could be a novel anti-tumor effect of tumor necrosis factor-α, independent of interleukin-10 upregulation. A Becker nevus is a mild hypermelanotic nevus that predominates in men on the arms, chest, or lower back, and a capillary or sacro-caudal cyst that contains remnants of hair and skin.
In summary, the use of IPL, versatility in the treatment of many dermatological diseases, as well as lower commercial costs and newer technology related to the square shape of the pulse and the use of the so-called double filters and a sequential multi-pulsing mechanism, different sizes and shapes of treatment spots and an integrated cooling system are strong advantages of the IPL technology compared to laser devices.
Square or calibrated pulse technologies have eliminated the emission of sigmoid-shaped pulses, which is another weak point of older IPL devices. In the case of non-square shaped pulses, changes in the spectrum distribution and fluence in the pulse cannot be avoided.
Various sizes and shapes of spots, which are allowed by modern IPL, shorten the time needed for photo rejuvenation sessions, and allow great freedom in targeting the treatment area.
Double filters allow for more targeted manipulation of different wavelengths of light and ‘cutting out’ unwanted bands in the middle of the spectrum.
Sequential multiple pulsing allows you to safely heat the chromophore without exposing the surrounding tissues to burns.
Cooling is an inherent treatment parameter that cannot be forgotten in IPL treatments. The built-in cooling system is a great help for every practitioner. It saves time and reduces the pain sensations of patients.
This can range from photo epilation to the treatment of several skin conditions, for which IPL is often the first choice. However, it is worth considering and carefully rethinking your qualifications and powers when it comes to skin diseases – is it an aesthetic or therapeutic effect?
The low handling difficulties and the weight of the handle containing both the lamp and the lamp cooling system is a small price to pay for all the advantages of the most advanced IPL technologies.
Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983;220:524-7. [PubMed] [Google Scholar]
Haedersdal M, Beerwerth F, Nash JF. Laser and intense pulsed light hair removal technologies: from professional to home use. Br J Dermatol 2011;165:31-6. [PubMed] [Google Scholar]
Dierickx CC. Hair removal by lasers and intense pulsed light sources. Dermatol Clin 2002;20:135-46. [PubMed] [Google Scholar]
Goldman MP. Treatment of benign vascular lesions with the Photoderm VL high-intensity pulsed light source. Adv Dermatol 1997;13:503-21. [PubMed] [Google Scholar]
DiBernardo BE, Pozner JN. Intense pulsed light therapy for skin rejuvenation. Clin Plast Surg 2016;43:535-40. [PubMed] [Google Scholar]
Drosner M, Adatto M, European Society for Laser Dermatology Photoepilation: guidelines for care from the European Society for Laser Dermatology (ESLD). J Cosmet Laser Ther 2005;7:33-8. [PubMed] [Google Scholar]
Serrano-Grau P, Campo-Voegeli A, Romero D. Photodepilation. Actas Dermosifiliogr 2009;100:351-61. [PubMed] [Google Scholar]
Mandt N, Troilius A, Drosner M. Epilation today: physiology of the hair follicle and clinical photo-epilation. J Investig Dermatol Symp Proc 2005;10:271-4. [PubMed] [Google Scholar]
Klein A, Steinert S, Baeumler W, et al. Photoepilation with a diode laser vs. intense pulsed light: a randomized, intrapatient left-to-right trial. Br J Dermatol 2013;168:1287-93. [PubMed] [Google Scholar]
Ormiga P, Ishida CE, Boechat A, Ramos-E-Silva M. Comparison of the effect of diode laser versus intense pulsed light in axillary hair removal. Dermatol Surg 2014;40:1061-9. [PubMed] [Google Scholar]
Zaleska I, Atta-Motte M. Epilation results comparison: diode laser versus IPL. The effectiveness of diode laser epilation following non-coherent light therapy. Conference: EuroSciCon Conference on Dermatology and Skin April 2019 DOI: 10.13140/RG.2.2.35035.41762
Weiss RA, Weiss MA, Beasley KL. Rejuvenation of photoaged skin: 5 years results with intense pulsed light of the face, neck, and chest. Dermatol Surg 2002;28:1115-9. [PubMed] [Google Scholar]
Prieto VG, Diwan AH, Shea CR, et al. Effects of intense pulsed light and the 1,064 nm Nd:YAG laser on sun-damaged human skin: histologic and immunohistochemical analysis. Dermatol Surg 2005;31:522-5. [PubMed] [Google Scholar]
Erol OO, Gurlek A, Agaoglu G, et al. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL). Aesthetic Plast Surg 2008;32:902-9. [PubMed] [Google Scholar]
Morais P, Santos AL, Baudrier T, et al. Angiokeratomas of Fabry successfully treated with intense pulsed light. J Cosmet Laser Ther 2008;10:218-22. [PubMed] [Google Scholar]
Galeckas KJ, Collins M, Ross EV, Uebelhoer NS. Split-face treatment of facial dyschromia: pulsed dye laser with a compression handpiece versus intense pulsed light. Dermatol Surg 2008;34:672-80. [PubMed] [Google Scholar]
Bjerring P, Christiansen K. Intense pulsed light source for treatment of small melanocytic nevi and solar lentigines. J Cutan Laser Ther 2000;2:177-81. [PubMed] [Google Scholar]
Piccolo D, Di Marcantonio D, Crisman G, et al. Unconventional use of intense pulsed light. Biomed Res Int 2014; 2014:618206. [PMC free article] [PubMed] [Google Scholar]
Barakat MT, Moftah NH, El Khayyat MA, Abdelhakim ZA. Significant reduction of inflammation and sebaceous glands size in acne vulgaris lesions after intense pulsed light treatment. Dermatol Ther 2017. [Epub ahead of print]. [PubMed] [Google Scholar]
Babilas P, Schreml S, Szeimies RM, Landthaler M. Intense pulsed light (IPL): a review. Lasers Surg Med 2010;42:93-104. [PubMed] [Google Scholar]
Mohamed EE, Tawfik K, Elsaie M. Intense pulsed light versus 1,064 long-pulsed neodymium:yttrium-aluminum-garnet laser in the treatment of facial acne vulgaris. J Clin Diagn Res 2016; 10:WC01-3. [PMC free article] [PubMed] [Google Scholar]
Tanghetti EA. Split-face randomized treatment of facial telangiectasia comparing pulsed dye laser and an intense pulsed light handpiece. Lasers Surg Med 2012;44:97-102. [PubMed] [Google Scholar]
Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for the treatment of dye laser resistant port-wine stains. J Cosmet Laser Ther 2003;5:7-13. [PubMed] [Google Scholar]