- Best Results1-2 sessions
- Treatment Recovery5-8 days
- Procedure Time30 minutes
- Skin SpecialistDavin Lim, nurse
- Duration of Results2-5+ years
- AnaestheticLocal, sedation
- Back to Work2-7 days
- Cost$$-$$$$
Lasers for solar keratosis
There are many ways to treat solar keratosis or sunspots, including the use of over a dozen lasers. Ask your skin specialist about these treatment options as the latest studies have shown that laser assisted delivery of chemicals such as ALA yields the best results with the least amount of downtime. Your doctor will have a logical reasoning for using their preferred method.
FactsFacts on Lasers for Solar & Actinic Keratosis
- Lasers can be used alone or combined with chemicals to treat solar keratosis
- My most common laser used is the thulium 1927 in high density passes
- This can be combined with retinoic acid or aminolevulinic acid, or PDT
- Limited joule, high density CO2 can also be combined with the above
- Lasers in combination with PDT can address thicker & pigmented sun spots
- Laser assisted PDT has the highest clearance rates of actinic keratosis
- Recovery from laser therapy is much quicker compared to Efudix or Aldara
- There are over 25 ways to use lasers for sunspots, hopefully this page will clarify what is in the scientific literature
What types of lasers are used to treat sun spots?
I use three main lasers to treat sunspots. They include-
Thulium 1927 in a high-density setting. This laser wavelength accounts for the majority of sunspot treatments that I perform. High density means high pass, resulting in 92% coverage of treated skin. Recovery takes 4-6 days. This can be a stand-alone treatment, combined with PDT or photodynamic therapy, or retinoic acid.
CO2 fractional laser resurfacing; low energy high density. This is best for sunspots associated with age spots, sebaceous hyperplasia & wrinkling. CO2 can be a stand-alone or combined with retinoic acid or PDT.
Erbium & CO2 full resurfacing; this treatment is performed by me. It is an epic treatment that gives epic results. Best for severe wrinkles, laxity, sun damage, smokers’ lines & marked photoaging. 8-14 day recovery but takes your skin back 10 to 20 years.
What is the best laser based upon the severity of sunspots?
Mild sun damage: opt for a thulium high density session. One session in most cases.
Recovery: 4-6 days
Cost: From $1290
Comments: Best for mild to moderate sun damage, will also improve fine lines.
Moderate sun damage: Thulium HD & CO2. One session.
Recovery: 5-7days
Cost: From $1790
Comments: Also treats wrinkles, spots, warts & pigmentation.
Severe sun damage: Erbium, HD Thulium & CO2 mix. One session.
Recovery: 8-14 days
Cost: From $1990 – $6990
Comments: Treats deep wrinkles, smokers’ lines, rejuvenation of 1-2 decades.
How do you know what is the best treatment for your skin?
Confused? If you have mild sun damage, & would like a reduction in solar keratosis, book an appointment with my nurses at Clinic Cutis.
If you have a history of solar keratosis, with moderate to severe sun damage, or you would like to have an assessment done, book an appointment with myself or one of my colleagues. We are all dermatologists; a referral is required.
How does laser therapy compare to other treatments for solar keratosis?
Favourably. To date the highest clearance rate of over 90% has been reported with fractional CO2 assisted short contact (30 minutes) laser assisted PDT. The illumination was with blue light.
The main advantage of lasers compared to creams for solar keratosis is the much faster recovery following laser treatment. Lasers also address the cosmetic issues of photoaging, including lines, wrinkles, pigment & barnacles.
View our Treatment Gallery
What is laser assisted PDT?
This treatment uses one of three lasers to accelerate the penetration of aminolaevulinic acid or ALA. This chemical is used for photodynamic therapy or PDT. Lasers work by breaching the upper layer of the skin, namely the stratum corneum. This allows more chemicals to be delivered into the deeper layers. I use thulium 1927, NA 1550 -1440 & fractional CO2 lasers to assist in penetration of ALA.
Can you tell me more about thulium HD resurfacing?
This is a technique I developed a decade ago for the treatment of sunspots. Most dermatologists employ this method of resurfacing. It is markedly different from ‘Fraxel laser resurfacing.’ HD resurfacing-
- Concentrates on areas of dysplasia
- Passes are 2-4 times higher in areas of solar keratosis
- Requires only one (sometime two) sessions
- Clears up to 80-90% of sunspots
- Can be combined with retinoic acid or PDT
- Has a downtime of 4-6 days
Experimenting with laser assisted delivery of retinoids AKA: LARI or laser assisted retinoid infusion 2.0
.
🔬Skin science: approximately 1-2% of topical retinol is absorbed by the skin. It requires conversion to retinoic acid for activity. Stuff that, too many variables, too many steps before it is biochemically active
.
👍🏻The Concept: increase absorption by a factor of 20-50. I have been using small spot super dense, low energy CO2 fractional lasers. They work infinitely better than NA lasers. Last week I nearly tripled the spot size to 300 microns. This week it’s 500 microns, super dense with adjusted joules (due to bigger spot size)
.
🧪The molecule: I have been playing around with retinoic acid 1-5%, trifarotene, & today #tazarotene (third gen retinoid). I would have continued with #trifarotene, but it is patented, so I can’t increase my concentration. Solution? Tazarotene at 5 mg/ml (5-10x stronger than prescription, when it was available)
.
🧬Hopeful outcome: retinoid bomb topically, MOAR - monther of all retinoids, it’s probably 1000X more acitve than topical retinol. Hopefully peel for 4-8 days
.
🔎Aiming to improve: skin quality- wrinkles, pores, pigment, etc…
.
💯Stay tuned
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
#retinol #retinoids #retinoicacid #retinoltips #retinolskincare #differin #acnetips #co2laser #skincaretips #skincarescience #skinscience
Off label thulium 1927, one session only. 20mj 22 passes to achieve 92% coverage
.
🔫Laser: Fraxel 1927 in HD or high density settings. At 92% it is still non-ablative
.
👍🏻The wavelength, even with the less ‘powerful’ diode cf. thulium is pretty special. Just finished comparing histology with the 1940 & low & behold it is around 200 microns across the board .. from 3 different laser companies. The dermal remodeling from such superficial penetration is so much more than bulk heating, probably related to cytokine release we have yet to fully understand, same goes to the non selective effects this wavelength has on the vessels 😱😱😱
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#laserdermatologist #fraxel #fraxeldual #thuliumlaser #laserresurfacing #fractionallaser #laseMd #fraxpro #laserrejuvenation #skinscience
What is fractional CO2 laser assisted delivery?
This can get really confusing. CO2 in the context of laser assisted delivery (as compared to fully ablative CO2), uses very low power but high coverage. This low power allows me to efficiently deliver retinoic acid or ALA into the deeper layers of skin.
The advantage of CO2 is that we can tune the beam to treat “spots & dots” including sebaceous hyperplasia, seborrheic warts & macular seb ks- pigment.
What is fully ablative CO2 laser resurfacing?
This treatment can be performed as a fractional, or as a fully ablative resurfacing. As the name suggests, a fractional laser treats only a portion of the surface area, typically 10-35% (in the context of CO2). Fully ablative lasers treat 100%.
The advantage of fully ablative CO2 is that it addresses solar keratosis, pigmentation, superficial skin cancers, as well as deep wrinkles. The disadvantage of this treatment is the recovery time (typically 12 days) & the costs, approximately six thousand dollars. Fractional lasers can give good results, with one third the downtime & costs.
What is pulse dye laser activated photodynamic therapy?
This treatment uses pulse dye laser in the spectrum of 585 to 595 nm to activate the ALA or mALA (Photosensitisers). The theory behind this treatment is to cut down the illumination time & discomfort experienced with normal PDT.
Studies have shown that it is not as effective as daylight PDT or normal PDT. I do agree as I did use this treatment more than a decade ago.
*SImple math. Illumination is 37j/cm2 for 630+nm, PDL delivers 6-7 joules per shot. To get the same energy level, I need to cover the face 6 times with a laser. It takes longer to perform this procedure compared to normal illumination. PDL is best used separately to treat redness associated with chronic UV exposure or rebound rosacea.
Which is better, blue LED or red LED?
Australians, the UK & Europe use red light sources in the range of 620-633 nm to activate porphyrins. The US uses blue light in the range of 415 to 450+nm. Which is better? There are high absorption peaks in both (higher in blue), but red light penetrates deeper. Hence there are arguments for both.
Daylight PDT, on the other hand, uses natural light that has blue & red wavelengths, hence why in many papers, this modality is preferred. Be guided by your dermatologists.
What is IPL photodynamic therapy?
IPL or intense pulsed light PDT uses both blue & red light delivered with filters. These wavelengths activate ALA, in turn killing abnormal or dysplastic cells including solar keratosis. The advantage of IPL treatment is that cosmetic concerns such as redness & brown pigment can be simultaneously treated, along with sunspots.
Given the marked amount of photodamage in Queensland, most patients require 2-3 sessions of IPL PDT for best results.
What are laser assisted retinoic acid peels?
One of my favourite treatments. This combines the science of laser resurfacing & the chemistry of skincare, namely retinoic acid. Retinoic acid reduces dysplastic cells, stimulates collagen, thickens the epidermis, compacts the stratum corneum, & reduces pigmentation.
Retinoic acid & Laser: Thulium HD or CO2. One session. Moderate sun damage.
Recovery: 5-7days
Cost: From $1390
Comments: Also treats wrinkles, spots, warts & pigmentation.
How does laser treatment by a specialist differ from cosmetic laser?
Specialists are job centric, namely, to treat the problem without the fluff (though there are some dermatologists who sell their services on Google). Dermatologists employ many methods to address sun damage from a medical point of view. In this context, lasers are used to reduce the malignant potential & treat dysplasia.
Are LEDs the same as lasers?
Nope. LLED or low-level laser energy devices – light emitting diode is a marketing term for normal LED lights, like the one in your house. Or the headlights on your car. It doesn’t mean that LEDs are sh*t, as I use them on a daily basis for wound healing & treating acne.
Refer to the articles below. Daylight has the same action spectrum of LEDs, but a laser lamp looks special, hence why clinics use this. So that they can charge you.
Davin’s Viewpoint on Lasers for Solar Keratosis
This is, by far, one of the biggest & most confusing topics for consumers (and also many junior physicians to understand). There is a dearth of energy devices used to treat sunspots or solar keratosis. An overview is as follows-
Lasers & devices to assist in delivery of chemicals include, fractional CO2, fractional erbium, fully ablative erbium with a micropeel, microneedling, CO2 & RF, lasers with shock wave pulse, non-ablative 1927, 1940, 1440, 1540, 1550 more. Some of these have been used in isolation, & in other cases combined with each other.
Add the various chemicals that have been used (in the context of solar keratosis treatment), and they include ALA, mALA, retinoic acid from 0.5 to 5%, 5FU. They range from short contact, 15 minutes, to long contact 3 hours.
Now add the illumination sources. They include daylight action spectrum with varied exposure time of 1-3 hours, varied longitude & lux. Other sources include LEDs, including blue & red in various power (joules). IPL with different filters have been used, as have Pulse Dye Lasers.
Now, multiple the three variables, namely lasers for delivery, chemicals, & illumination together with various sites of solar keratosis (scalp, face, chest, arms, hands), then look at the follow ups, 3, 6, 12, 8 months. Consider the different types of solar keratoses, pigmented, hypertrophic, confluent, as well as the immunology of the patient, immunocompetent vs immunosuppressed. Get it? Every month there is a new paper that adds to the variables.
If I could simplify things, the best treatment for most people is high density thulium. I do use PDT if there is significant dysplasia. For solar keratosis with age related changes, it is the above with CO2 fractional. My preferred PDT is daylight.
For really sun weathered skin, namely patients living in high UV exposure areas like Gold Coast, Sunshine Coast, my preferred is Erbium & CO2 fully ablative resurfacing.
