L ight

A mplification by the
S timulated
E mission of
R adiation
 L stands for Light

• many colors • one color

• doesn't come in a narrow beam
• can‘t be focused to as a small spot
• can’t be as intense as a laser without
expending tremendous amounts of
energy.
• thin beam
• can be focused to a tiny spot.
• can be made very intense / not intense
at all
 A in laser stands for amplification
 A very bright intense beam of light can be created.
 The laser may be activated by a few photons, but then many,
many more are generated.
 The initial light is amplified to make a very bright compact beam.
S in laser stands for stimulated.
Stimulated → the photons are amplified by stimulating an
atom to release more photons
The atom is stimulated by another photon to release its
photon.
• Emission → giving off of photons.
• The excited atom emits a photon when another photon comes by.
• In 1917, Einstein → Stimulated Emission.
in laser stands for radiation.

Radiation → bad reputation.

For lasers→ radiation refers to
the photons which are being
emitted.
Monochromatic
Collimation
Coherence
 Continues wave : emisi terus menerus.

 Shuttering : mekanisme “buka tutup”

 Pulsed/superpulsed : sejumlah emisi intensitas

tinggi dengan interval waktu.

 Q-Switched : energi dikumpulkan di “optic

cavity” sebelum diemisikan
 BEAM TYPE

Power (W)

100

Time ( sec )
Continuous Wave
 BEAM TYPE

Power (W)

100

Time ( sec )
Shuttered Continuous Wave
 BEAM TYPE

Power (W)

1000

Time ( msec )
Pulsed
 BEAM TYPE

Power (W)

2000

Time ( msec )
Superpulsed
 BEAM TYPE

Power (W)

1 x 106

Time ( nsec )
Q-Switched
TISSUE OPTICS
TYPICAL CHROMOPHORE
BIOLOGIC EFFECT
SELECTIVE PHOTOTHERMOLYSIS
PARAMETERS OF LASER LIGHT
● REFLECTION
● ABSORPTION
● SCATTERING
● TRANSMISSION
 ● REFLECTION

- about 4-6% of light reflected

 ● ABSORPTION
The transformation of radiant energy to another form of
energy ( usually heat) by interacting with matter
the most important step to achieve any reaction
Grothus Draper Law (No Absorption No Effect)
result : thermal or non-thermal reaction
based on the beer’s law, 90% of lights is absorbed in
epidermis
 ● SCATTERING

Imprecise absorption of laser energy by a biologic system

resulting in a diffuse effect on tissue
mainly forward in direction
may result in light passing back through the medium (back-
scattering)
wavelength 600 – 1200 nm = optical windows → low
scattering
 ● TRANSMISSION
The passage of laser energy through a biologic
tissue without producing any effect
wavelength < 300nm-400nm penetrating < 0,1 mm
wavelength 600-1200nm penetrating deeper with
less scattering
Tissue/Cell content : 70 - 80 % are water
CO2 Laser irradiation --> immediately
* Absorb by water in the cell
* Convert to Heat --> vapor
* Build up intracellular pressure
* Cell Explosion
Explosion ->Evaporation/ablation
Depth of Penetration :
Pulse CO2 Laser --> 50 - 100 micron
Ebrium YAG Laser --> 10 - 30 micron
LSR requirement :
* High Power Density
* Short Irradiation Time --->Shorter than
“ Thermal Relaxation Time”
 Light-tissue interactions can be
broken down into :

The transport of light in tissue

Absorption of light and heat generation
in tissue
Localized temperature elevation in
the target tissue
Diffusion away from the target
Hemoglobin and oxy-hemoglobin
Melanin, Melanosome
Collagen
Water
Tatto Ink
Absorption of Chromophoresgraph
● Photothermal
▪ Thermal injury to cells
▪ Coagulation
▪ Vaporization
● Photo Chemical
▪ Photodynamic reactions
● Photostimulation
● Photomechanical
• Tissue interactions →Transformation
of Light Energy into Thermal Energy.
• Effect : destroy pathologic tissue -->
Coagulate, Vaporize, Ablate, Cut.
• “ THERMAL EFFECT “.
• 1967 : Endre Mester -- Carcinogenic Effect
---> observered hair growth after laser
irradiation in depilated mice.
• He named it LASER BIOSTIMULATION
• “ NON - THERMAL EFFECT “
• Low Power Laser Irradiation
 Thermal Injury to cells

● < 43º C : the skin remain unharmed

● 43 - 50º C : tissue necrosis (after several
minutes)
● 45º C : fibroblast die after about 20
minutes
● 70 - 100º C : irreversible thermal damage
Collagen Reaction to Temperature Elevation
- Less than 40o C : no effect
- 40o – 53o C : Protein Denaturation
- 55o – 60o C : Protein Degradation
- 63o – 90o C : Protein Coagulation.
 Coagulation
● Maybe reversible or irreversible
● ≥ 61 – 63º C :
▫ reversible non-lethal thermal damage =
collagen shrinkage
● 61- 71º C :
▪ The goal of laser resurfacing
▪ Achieve the desired shrinkage of collagen
without completely denaturating collagen
 Vaporization

● 70 - 100º C : irreversible thermal

damage and denaturation
→ tissue necrosis
● 100º C : vaporization
● 100 - 120º C : fluctuation between
vaporization and charring
● 120 - 200º C : charring occurs
"photo“ → light
"thermo“ → heat
"lysis“ → destruction.
Selective photothermolysis therefore refers to the
precise targeting of a structure or tissue using a specific
wavelength of light with the intention of absorbing light
into that target area alone. The energy directed into the
target area produces sufficient heat to damage the target
while allowing the surrounding area to remain relatively
untouched.
♣ WAVELENGTH
♣ PULSED DURATION
♣ ENERGY FLUENCE
♣ IRRADIANCE
♣ SPOT SIZE
♣ TISSUE COOLING
 WAVELENGTH
● Spesific wavelength → will be absorbed
by specific chromophore
If more than 1 chromophore
→ absorption will be divided
→ competitive absorption
● Wavelength should be near the max. absorption
of target chromophore & minimum competitive
from other chromophore
 PULSE DURATION
Pulse Duration or pulse width is the amount of
time it takes to deliver the energy.
The pulse duration must be shorter than the
thermal relaxation time of the target. If the pulse
duration is longer than the thermal relaxation
time, the surrounding tissue receives thermal
damage.
 THERMAL RELAXATION TIME (TRT)
= waktu yang dibutuhkan untuk jaringan
yang dilaser kehilangan 50 % dari
panasnya melalui difusi.
Besaran waktu : 100 mikro detik hingga
10 millidetik.
 ENERGY FLUENCE
● The energy delivered per unit area
● As it increases the destructive force
increases
● For most pulsed lasers

ENERGY FLUENCE = Laser power output x pulse duration

Laser beam cross-sectional area

ENERGY FLUENCE = Joules = Watts x sec

cm² cm²
 IRRADIANCE
● The rate of energy delivery per unit area to an
object = Power Density
● Generally used when referring to continuous
wave laser, ec. CO2 Laser

IRRADIANCE = ______Laser power output____ = Watts

Laser beam cross-sectional area cm²

WATTS = Joules
Sec
 SPOT SIZE
Defined as the width of the laser beam.
Spot size determines the area to be treated.
Lasers vary widely on the spot sizes available for use.
Spot sizes determine the depth of penetration.
The larger the spot size of the laser beam, the more
fluence must be used to achieve the same result.
Lasers have limits as to the amount of energy that can
be used with the larger spot sizes. Another advantage of
the larger spot size is the ability to treat larger areas of
the body very quickly.
 TISSUE COOLING

● Cooling Method
▪ Cold air cooling
▪ Contact cooling
▪ Dynamic cooling
Cold Air Cooling
Contact Cooling
Dynamic Cooling
 ■ The Role of Cooling

Reduce discomfort during treatment,

protect epidermis and collateral dermal
damage, allow using higher fluence and
reducing number of treatments
 TERMINOLOGI

POWER = ukuran kemampuan kerja

yang diukur dalam Joule/detik = Watt.
POWER DENSITY = besar daya yang
disampaikan per satuan luas yang diukur
dalam Watt/cm2
ENERGY = kapasitas kerja diukur dalam
JOULE / watt x waktu
FLUENCE = total energi yang di-
sampaikan per-unit luas = Joule/cm2
SPOT SIZE = besar bercak laser pada
target diukur diameternya namun dalam
perhitungan dalam satuan luas (mm2)
PULSE ENERGY = energi dari satu pulsa
dari SuperPulse atau UltraPulse -- mjoule
-> pulsa sangat pendek, Peak Power
tinggi