Treatment of Complications Associated With Intense Pulsed Light
Intense pulsed light (IPL), broadband light (BBL), photorejuvenation and fotofacial are all terms that refer to a technology that has been available for several years to rejuvenate the skin. Most laser companies have their own version of this technology incorporating a broad band of non-coherent light waves that range from 560 nm to 1200 nm. Various targets in the skin absorb different wavelengths. Due to the range of wavelengths, a decrease in the appearance of fine lines, pore size, hyperpigmentation and erythema are observed, along with improved elasticity. The American Society of Aesthetic Plastic Surgery reported in 2009 that more than $215 million was spent in the US for these procedures. Today it is still one of the most popular nonablative procedures.
Photorejuvenation is not without complications. Earlier devices that pioneered the procedure were called Photo-Derm and became known as "Photo-Burn" due to the complications that occurred. With advanced technology, use of cut-off filters and cooling mechanisms within devices, the incidence of burns has significantly reduced, but still occur.
The patient's skin type and a clear history of recent sun exposure are critical factors to consider before treating patients with photorejuvenation. Patients who have had photorejuvenation in the past using the same device and settings can be burned on a subsequent treatment if they had significantly more sun exposure since the previous treatment.
Off-the-face treatments on the neck, chest, back or extremities require extreme caution. Usually, parameters used on the face are too high for off-the-face areas. Patients are usually frantic and upset when they see footprint burns a few hours later, followed by blistering and dyspigmentation. The areas of burn appear much lighter than skipped areas. This is disfiguring and creates prolonged social downtime.
The décolleté and upper back are the most common areas of dyspigmentation that present to our clinic. The décolleté is usually treated for extensive sun damage and upper back is usually treated for hyperpigmented scars from acne.
Fortunately, continued treatment with photorejuvenation usually helps resolve the complications. After the skin has re-epithelialized I have patients use a compound of a combination tretinoin and bleaching agents as well as sun block and continue with photorejuvenation treatments 3 to 4 weeks apart, with intermittent microdermabrasion and/or chemical peels Understandably, most patients are very reluctant to try this approach, but in the long run patients are very pleased with the results.