Laser Dermatology: Pearls and Problems

200 Pages·2007·16.095 MB·English

by  David J. Goldberg

Laser Dermatology
The writing of any book requires hours of work, rework, and
more work. This book could not have been written without
the tireless efforts of my 2006 Procedural Dermatology fellow,
Dr. Alexander L. Berlin. I cannot thank him enough.
Laser
Dermatology
Pearls and Problems
David J. Goldberg
MD, JD
Skin Laser & Surgery Specialists of New York & New Jersey
Mount Sinai School of Medicine, New York, NY
UMDNJ-New Jersey Medical School, Newark, NJ
Fordham Law School, New York, NY
© 2008 David J. Goldberg
Published by Blackwell Publishing
Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020,
USA
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053,
Australia
The right of the Author to be identifi ed as the Author of this Work has been
asserted in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored
in a retrieval system, or transmitted, in any form or by any means, electronic,
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UK Copyright, Designs and Patents Act 1988, without the prior permission of
the publisher.
First published
1 2008
Library of Congress Cataloging-in-Publication Data
Goldberg, David J., M.D.
Laser dermatology : pearls and problems / David J. Goldberg.
p.; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4051-3420-0
1. Skin—Laser surgery. I. Title.
[DNLM: 1. Skin Diseases—surgery. 2. Cosmetic Techniques. 3. Laser Surgery.
4. Skin Aging. WR 650 G618L 2008]
RL120.L37G64 2008
617.4’770598—dc22 2007015635
ISBN-13: 978-1-4051-3420-0
A catalogue record for this title is available from the British Library
Set by Charon Tec Ltd (A Macmillan Company), Chennai, India
Printed and bound in Singapore by Fabulous Printers Pte Ltd
Commissioning Editor: Martin Sugden
Editorial Assistant: Jennifer Seward
Development Editor: Elisabeth Dodds
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Blackwell Publishing makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check that any
product mentioned in this publication is used in accordance with the prescribing
information prepared by the manufacturers. The author and the publishers do
not accept responsibility or legal liability for any errors in the text or for the
misuse or misapplication of material in this book.
vv
Contents
Foreword, vii
Preface, ix
1 Vascular Lasers, 1
2 Laser Hair Removal, 35
3 Pigmented Lesions, Tattoos, and Disorders of
Hypopigmentation, 71
4 Ablative Lasers and Devices, 115
5 Non-Ablative Photorejuvenation and
Skin Remodeling, 153
Index, 185
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vii
Foreword
Enthusiasm and knowledge only go so far. But industrious
capitalization of these features can result in infectious and
signifi cant achievements with long lasting benefi ts. And so
David Goldberg’s excellent review of energy based systems
entitled Laser Dermatology: Pearls and Problems is arriving at a
most propitious time.
Not so long ago, there were only a few therapeutic lasers
available and the choices were easy. It was all about how to
use the continuous wave CO laser in one of its three modes—
2
cutting, vaporization, or coagulation—which all related to spot
size and power. Or how to improve the appearance of port
wine stains with the argon or copper vapor lasers without scar-
ring the heck out of the patient. In retrospect, we used to do
a pretty good job considering the lack of selectivity and low
tissue tolerance for these devices. There were few “Problems”
and even fewer in the way of “Pearls.”
But now it’s a different ball game. The varying different
energy based devices (not just lasers) are numerous, more
selective, safer, and in many cases less effective than we would
like them to be. Problems can exist if they are not used appro-
priately. Pearls come through the experience of using such
devices effectively. This book moves beyond laser and light
based wavelengths, fl uences and pulse durations and focuses
on the wealth of experience of one of today’s leaders in laser
dermatology.
Dr. Goldberg should be congratulated for bringing together
a very practical compilation of the pearls and problems in
the current practice of laser dermatology. His well presented,
organized series of concepts will be extremely useful for the
experienced laser surgeon as well as the novice. Very evident
in this book is the accuracy and honesty of the author. Laser
dermatology is exciting. Laser Dermatology: Pearls and Problems
is an essential read for all physicians interested in the nuances
of this fi eld.
Christopher B. Zachary, FRCP
Professor and Chair
Department of Dermatology
University of California-Irvine
July 2007
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ix
Preface
Laser Dermatology: Pearls and Problems is not meant to be just
another book written about lasers in dermatology. There are
plenty of such books already written on that topic – some by
me. All other books dealing with this vast arena either focus
on (a) the skin entities that can be treated with lasers; (b) the
latest in dermatological lasers; or (c) complications that may
induced by those lasers. Where this book is different is the
manner in which it looks at lasers in dermatology. This book
is divided into fi ve chapters. Each chapter starts off by high-
lighting essential concepts. This is then followed by a focus
on pearls and problems of fi ve major areas of laser dermatol-
ogy. In addition, the photographs contained within each of the
chapters are meant to serve a different purpose than is seen
with most textbooks. The focus of pictures in this book is not to
present before and after photographs. Such a focus is contained
in many outstanding textbooks. Although there are occasional
before and after pictures contained within the text, the focus,
in this book, is to use pictures to illustrate some of the many
pearls and problems that can be seen in the realm of laser der-
matology. Twenty years of laser dermatology have given me a
chance to see the beauty of the “Pearls” and the diffi culties of
the “Problems” in Laser Dermatology. Enjoy!
David J. Goldberg, MD, JD
March 2007