Q-SWITCH LASER FOR PIGMENTATION

Dr Anil Ganjoo, MD, is a senior Consultant Dermatologist and the President of SAARC AAD. He heads the department of dermatology in several prestigious institutions of Delhi such as Sunder Lal Jain Hospital, Saroj Hospital, and The Institute of Nuclear Medicine and Allied Sciences, Delhi. He is the founding member of the IADVL, SIG on lasers, and has over 5,000 laser surgeries to his credit.

Know more from Dr Ganjoo on Q-Switch Laser (QSL) for Pigmentation:

Who is a good candidate for this treatment?

A good patient would be the one with realistic expectations from the procedure and whose skin is less likely to develop post inflammatory hyperpigmentation. Also, there are certain conditions that do well with the QSLs such as the Nevus of Ota, post inflammatory hyperpigmentation, photo pigmentation, and dull skin.

How can best results be derived and tell us about the technique.

The results can be different, depending upon what you are treating. For example, a Nevus of Ota does well within five to seven sessions or a tattoo responds satisfactorily within five to eight sessions depending upon the depth and thickness of the pigment.The newer machines have a huge parameter variability and different types of hand pieces that make the Q-Switch lasers one of the most versatile machines in the present times.

Q switching basically delivers high bursts of energy in ultra-short pulses ranging from a few picoseconds to nanoseconds.This ensures that the energy is absorbed by just the pigment in the lesion and the surrounding areas are completely spared.Therefore, there is selective destruction of the target through a process called “Selective Photothermolysis”.

The best results can be achieved by preparing the patient well, using the best parameters appropriate for that particular condition and giving a good post-operative regime.

What is the recovery time for a patient who undergoes this treatment?

This depends on the condition treated and the parameters employed. For example, in patients of Nevus of Ota or tattoos, we employ aggressive parameters and therefore the downtime can last up to 7 to 10 days. In newer procedures such as the carbon peel or laser toning, there is hardly any downtime involved, and in fact, these are also called lunchtime procedures where the patient just walks in, gets the procedure done and walks out with a glowing and shining skin, ready to attend a party or an event.

Any contraindications involved that one should be aware off?

The major contraindication is unrealistic expectations. So, the patients need to be counselled and explained about the likely outcome. Other relative contraindications include a dark skin that can tan easily as there is a likelihood of post inflammatory hyperpigmentation happening following the procedure. It is a good practice to prime this kind of skin prior to the procedure. Priming involves the use of certain hypo pigmenting agents such as alpha hydroxy acid and retinoids for a period of two to four weeks before the procedure. Priming reduces the likelihood of post inflammatory hyper pigmentation and also improves the outcome. Also, sun protection and use of a broad-spectrum sunscreen is a must before and after the procedure.This goes a long way in preventing rebound pigmentation and improving the result further. I also consider conditions like the Becker’s nevus that have a poor outcome with QSL treatment to be a relative contraindication.Therefore, I discourage these patients from opting for the treatment as they remain dissatisfied with the procedure.

Tell us about a challenging case study for this treatment.

All my patients of Nevus of Ota have been a huge challenge and at the same time have given me the most satisfaction with quite gratifying results.These patients have had the patches on their faces right from their birth and believe that nothing can be done about it. When they get 70 to 80 per cent improvement in their congenital condition, the smiles on their faces are truly gratifying.