We live in a miraculous age. Thirty years ago, if I told most of the people reading this article that they could take a letter or picture and send it around the world in a matter of minutes, they would have thought that to be a massive advance. Enter the fax machine. If I told the same people 15 years ago that you could send text, pictures and video around the world in seconds, that would have been ultra miraculous. Enter the Internet and digital technology. Finally, if I told you just a few years ago that you would be able to carry your entire collection of record albums, 8-track tapes, cassettes and family movies on a device the size of a pack of cigarettes, you would have called me insane. We have seen so many technological advances over the past half century that we take them for granted. Television, polio vaccine, antibiotics, organ transplants, man on the moon, cellular phones, digital photography and iPods have changed the way we all live, work and play.
TOOLS THROUGH TIME The same exponential growth has been seen in cosmetic surgery. Prehistoric men utilized sharpened stones to cut flesh. The Bronze Age provided blades for incision and we remain pretty much stuck in that technology with our #15 scalpel blades. Shortly after the discovery of electricity, it was used to cauterize or burn tissue in the operating room. Early electrosurgical generators were basically soldering irons that could destroy tissue. By 1928, William Bovie, the famed Harvard surgeon, had harnessed the electricity to selectively cut and coagulate tissue. In 1999, the Ellman Company patented 4.0-radiowave technology, which was even more selective and controlled.
LASER LINEAGE Experimentation with light waves for military radar applications during WWII led Dr. Charles Townes to begin work on light emission with shorter wavelengths. In 1953, Townes and others demonstrated a working device, which Townes called the maser, which stands for Microwave Amplification by Stimulated Emission of Radiation. They patented the device through Columbia University. This work continued and the principle of reflecting mirrors was added. Townes together with Schawlow in 1958 wrote a paper on their work — although they had not yet made an actual laser — and they applied for a patent through Bell Labs. They proposed that the principles of the maser could be extended to the optical regions of the spectrum, which was published in the December issue of Physical Review. Two years later, schawlow and townes received a patent for the invention of the laser, the same year a working laser was built by theodore maiman at hughes aircraft company. Townes and schawlow went on to win nobel prizes for their work and interestingly quote their feelings at the time: "we thought it might have some communications and scientific uses, but we had no application in mind. If we had, it might have hampered us and not worked out as well."Given the fact that the inventors had no medical application in mind and appreciating this history, we went from 0 to100 miles per hour in 50 years. During this time, the theories of selective photothermolysis and thermal relaxation time opened the door for precision tissue selectivity and the pulse dye laser emerged as the first gold standard for selective chromophore destruction.
PROBLEMS AND PROGRESS Over the past 15 years, we have seen the development of ultra pulsed technology and computer pattern generators that led to the laser resurfacing revolution that all but made dermabrasion obsolete. The steep learning curve of the co2 laser, coupled with the media frenzy and corporate hype, proved that this new and effective technology could be fraught with problems. Disfiguring burns, permanent hypopigmentation and extended healing became problematic and the search continued. The erbium laser appeared on the scene as a more gentle, friendlier laser and although it required less recovery time, it also provided less dramatic results.
Ensuing technology with vascular lasers led from the 585-nm wavelength with it purpura to longer pulsed 595-nm wavelength with less purpura. NG:YAG lasers with cooling technology allowed the treatment of larger and deeper vascular lesions with less melanin absorption, which allowed its use in darker skin types. A super long-pulse diode laser of 810-nm wavelength allowed the laser energy to be delivered over a longer time which resulted in less epidermal damage and increased use with darker skin types. The 532-nm wavelength (also coupled with 940-nm wavelength) is generated with solid-state diode lasers that are clinical workhorses, as they are light and portable and produce little epidermal damage, making possible a lunchtime treatment.
In 1995, hair removal lasers were introduced and the long pulse alexandrite laser with a 755-nm wavelength became a popular option. Tattoo removal lasers also appeared, further extending the clinical usage of laser technology.