Is Cold Laser Therapy Right for You?

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What&#;s cold laser therapy?

Cold laser therapy is low-intensity laser therapy that stimulates healing while using low levels of light.

The technique is called &#;cold&#; laser therapy because the low levels of light aren&#;t enough to heat your body&#;s tissue. The level of light is low when compared to other forms of laser therapy, such as those used to destroy tumors and coagulate tissue.

Surgical and aesthetic lasers heat the tissue being treated. True to its name, cold laser therapy does not.

Cold laser therapy is also known as:

• low-level laser therapy (LLLT)
• low-power laser therapy (LPLT)
• soft laser biostimulation
• photobiomodulation

How does cold laser therapy work?

During this procedure, different wavelengths and outputs of low-level light are applied directly to a targeted area. The body tissue then absorbs the light. The red and near-infrared light cause a reaction, and the damaged cells respond with a physiological reaction that promotes regeneration.

Superficial tissue is commonly treated with wavelengths between 600 and 700 nanometers (nm). For deeper penetration, wavelengths between 780 and 950 nm are used.

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Although you&#;ll feel the laser device touching your skin, the procedure is painless and noninvasive. There will be no sound and you&#;ll feel no vibration or heat. Each treatment typically takes only a few minutes.

Is cold laser therapy for you?

The use of cold laser therapy is growing in traditional medical practice and as a complementary or alternative therapy. It&#;s approved by the U.S. Food and Drug Administration (FDA) for a number of conditions.

Cold laser therapy is considered safe when performed under the care of a doctor or qualified practitioner. On the plus side, it&#;s also noninvasive and painless. It doesn&#;t require medication or other preparation either.

That being said, cold laser therapy shouldn&#;t be used on carcinomas or cancerous lesions. It should also be avoided on the thyroid or eyes for home use. Since the effect of cold laser therapy on unborn children is unknown, it&#;s suggested that pregnant women avoid this type of treatment.

One of the drawbacks of this therapy may be time. While each cold laser therapy session only takes a few minutes, it may take as long as a month (with as many as four treatments a week) before you can gauge its effectiveness.

It also may not be covered by your insurance.

What&#;s the takeaway for people interested in cold laser therapy?

Research into the effectiveness and safety of cold laser therapy is ongoing. Not enough information on optimal treatment protocol is available. However, proponents feel that it can be a good alternative for people who want to avoid invasive treatments.

If you&#;re interested in cold laser therapy, speak with a doctor, physical therapist, or other medical professional to find out if it makes sense for you.

Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.

Since cooling is a mainstay in patient safety and helps achieving better results, it has become mandatory to ensure the presence of a cooling device in the laser set-up. It is recommended to have a cart carrying cooling device (about 2.5 feet × 2.5 feet) in the laser room. External cooling devices like Zimmer contain a compressor, so it is essential to have a separate electric circuit for the same. Provision should also be made for ice cubes or ice packs.[ 9 ]

Cooling protects the epidermis, as a result of which we can deliver high fluence laser beams to the skin. This is referred to as the &#;theory of spatial selectivity of the cooling&#;. To target the chromophores within blood vessel, stem cells, hair follicles, etc., a particular temperature should be reached. However that temperature will significantly damage the epidermal keratinocytes and melanocytes.[ 2 ] Cooling devices ensure the maintenance of a lower temperature at the epidermal level, yet reaching the required higher temperature at the target level. This is essential for the proper functioning of the laser beam.[ 3 ] Besides, cooling will diminish the amount of oedema, which often develops as a complication of laser procedure.[ 4 ] To be precise, the basic principle is to protect the superficial layers of the skin from collateral thermal damage. It can be achieved by cold air convection, contact cooling or cryogen spray (dynamic) cooling.[ 1 , 5 , 6 , 7 , 8 ]

The primary objective of laser therapy for patients with specific dermatoses is to maximise thermal damage to the target chromophores while minimising injury to the normal skin. However, in some cases, the threshold dose of incident laser beam for epidermal injury can be very close to the threshold for removal of the chromophore, thus questioning the administration of high doses. Dark-skinned patients are more susceptible to these problems on account of their increased epidermal melanin which competes as a significant chromophore for laser energy, leading to increased rate of pain, blistering, scarring and dyspigmentation. A method of dealing with this problem is to selectively cool the most superficial layers of the skin. It should be remembered that absorption of energy by melanin may lead to production of heat, but subsequent cooling of the epidermis shall prevent the elevation of temperature beyond the threshold temperature responsible for thermal injury.[ 1 ]

Cooling can be achieved before, during or after laser treatment, referred to as pre-cooling, parallel cooling and post-cooling, respectively.[ 10 ] On the basis of methods, cooling is of two types: contact cooling and non-contact cooling. Contact cooling can be achieved by active (copper, sapphire tips) or passive (ice or cold gels) methods. In contact cooling, tissue cooling is achieved by conduction of heat from the skin to the cooling device or substance placed directly onto the skin. In passive contact cooling, the device removes heat from the surface of the skin by energy transfer from the warm skin surface to a cold cooling agent by heating up the agent. However, in active contact cooling, the heat transposed to the device is actively removed by thermoelectric elements or flowing liquid cooling agents. In non-contact cooling, heat is actively removed from tissues through either evaporation or convection. Non-contact cooling can be achieved using cryogen spray or cold air. The various techniques are summarised in .

CONTACT SKIN COOLING

This is done using cooled sapphire metal or glass plates integrated into the handpiece, ice or chilled aqueous gels. It is in practice over decades, mainly used for anaesthesia in dermatosurgical procedures. To prevent or reduce swelling after a laser procedure, cooling with ice packs is advised on areas such as cheeks and neck until the pain and/or erythema disappears. The ice pack is ideally wrapped in a soft cloth and applied for 10-15 min/h for a maximum of 4 h until the burning sensation persists. Skin surface temperatures of 12°C can be achieved after 10 seconds of cooling. Application of ice packs may not be a very handy procedure, and it is best suited for large areas and in cases where sapphire tip cooling method is not available. It is mainly used in the treatment of port-wine stains, leg telangiectasia and hair removal. Ice cube cooling is a user-friendly method due to the simple process of placing an ice cube on the skin for several minutes. Besides, it is suitable for every laser device because it is either removed before laser therapy or therapy is performed through it (pre-cooling or parallel cooling). However, there are a few demerits of using ice cubes. The physician has to use both the hands to perform the therapy, and the cooling may take a few minutes before the laser irradiation can be started. The production of bubble-free ice cubes which is necessary for laser therapy may be a serious problem. In addition to the above problems, the patients might feel uncomfortable due to the melting water on their skin. Ice and chilled gels can be easily used to cool large areas of skin (bulk cooling), although it is messy in clinical practice.

It should be noted that application of aqueous gels is the least effective method. It involves the application of a sterilised, single use, hydrocolloid gel pad (non-adherent wound dressings) (e.g., &#;Vigilon&#;), which is pre-cooled in a household refrigerator and placed on the treatment area. The gel pad is cooled down to 8°C. After application, skin temperature rapidly decreases from 32°C to 23.5°C within 5 seconds but increases to 26.5°C after 10 seconds and to 27°C after 60 seconds, which is insufficient for laser treatment. Classical indications for this device are leg telangiectasias and port-wine stains. It can merely extract heat from the skin passively, which means that it is not capable of providing a prolonged cooling. Besides, the pressure and the low temperatures lead to blanching of the underlying blood vessels. As a result of this, there is diminished absorption of energy by haemoglobin, which often causes persistence of lesions.[11] There are a few disadvantages associated with this method. The skin lesion is covered by the pad, thus restricting the view of the treatment area and the gel pad leads to a defocused laser beam by scattering the light which reduces the effectiveness of the treatment. This method is rather discouraged these days.

Sapphire tip cooling or chill tip cooling is available in most of the lasers now. It offers a good method of cooling throughout the procedure (pre-, during- and post-cooling). It should be noted that the temperature of the tip is 4° before the shot, 0° during the shot and 4° again, after the shots are over.[10] It is most useful for treatment with longer pulse durations (>10 ms).[12] The sapphire tip contact cooling devices with thermoelectric elements are mostly integrated into the handpiece, those with liquid cooling agents are removable and attachable as required. The sapphire tip represents one of the most effective cooling devices. However, the cost of the handpiece, special laser, energy expenditures and cooling agents are limiting factors. Besides, the treatment needs to be performed blindly since the cooling device is non-transparent and directly integrated into the laser handpiece. In addition to being more efficient in heat extraction, active contact cooling offers manually controlled skin compression, diminishing the blood flow in superficial blood vessels; therefore, decreasing the oxyhaemoglobin which is an active chromophore. Furthermore, skin compression brings deeper targets like the hair follicles closer to the skin surface thus, maximising the absorption of the laser energy, so less fluence can be used to heat these targets. However, these devices require frequent cleaning after every 5&#;10 pulses to remove debris and disinfection of the tip between patients is mandatory to prevent skin infections.

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