激光美容存在的问题与对策(摘要)

激光美容存在的问题与对策(摘要)

高天文孙林潮李承新

第四军医大学西京医院全军皮肤病中心(陕西西安71003)

激光作为20世纪最重大的科技成就之一已载入史册。激光美容具有效果好、副作用小、安全性高等特点，然而激光美容中仍存在不少问题。我们应用VersaPulse多波长激光、VascuLight(Photo Dream)强光、LightSheer半导体激光、Quanturn嫩肤仪、Sharp~1080S超脉冲CO2激光、1030C超脉冲CO2激光Sharplan铒激光、Sharplan红宝石激光、LaserscopeOrion激光、连续和脉冲式Nd：YAG激光、连续Nd：YAP激光、调Q1064／532二合—激光及ClearTouch痤疮治疗仪等治疗各种皮肤疾患数万例。本文就我们的应用体会对激光美容存在的问题进行分析并提出对策。1.鲜红斑痣的激光治疗问题，鲜红斑痣激光治疗的最大问题是治愈率低，以往各种机器治愈率均未超过20％，VascuLtght强光与VersaPulse联合使用可提高治愈率。波长595nm的V-Beam能使疗效显著提高。2。色痣激光治疗问题：色(素)痣或黑痣是良性黑素细胞肿瘤的俗称，而不是一个疾病的诊断名称。激光治疗色痣可出现下列问题：1)不易彻底，常复发；2)过度治疗可致瘢痕；3)早期黑素瘤被误诊为色痣，激光治疗造成严重后果。为此我们主张不论出于预防恶变还是美容需要，色痣的正确治疗方法是手术切除并作病理检查。3．嫩肤除皱问题：我们有以下体会：1)效果：超脉冲CO2>铒激》强光；2)超脉冲CO2疗效好，但色素沉着重，不适于有色人种；3)粗皱纹选铒激光；4)铒激光致色素沉着风险小于人们的预计；5)光嫩肤只宜看作一种高级护肤设备，未发现有明显的除皱效果。4。强光嫩肤及治疗问题：目前强光被市场过度炒作，由于以次充好的机器的出现，市场混乱，致治疗无效，强光嫩肤的声誉已

受到严重影响。

Current Lasers in the Skin Cosmetic ------Problems and Solutions Tian wenGao Lin chaoSun Cheng xinLi

Department of Dermatology, Xijing Hospital, the Fourth Military Medical University,

Xl'an 710032, P.R.China

The approach to skin cosmetic, especially to facial skin cosmetic, has been dramatically enhanced by theapplication of current lasers over the past decade. Current lasers have raised a lot of interest, and it has already been widely employed in the treatment of many kinds skin disorders, for instance, vascular lesions, pigmented diseases, hypertrichosis and skin resurfacing. However, there still exist some problems. Firstly, the Q-switch-mode laser is very succe~ful in completely removing naevi of Ota, naevi of Ito, lentigos, freckles, and tattoos without any scarring or pigmentary disturbance, however, following Q-switched-mode laser treatment, many patients with pigmented uaevi have partial repigmentation within several months after discontinuation of therapy. In addition, it has been found that the number of recurrent pigmented macules increase and benign naevus even become malignant melanoma in some patients. Secondly, although current lasers are very effective in the treatment of angiomas, telangiectasias, vascular lesions of a few patients can not be completely removed even after several year's treatment. Finally, laser skin resurfacing has become a popular therapeutic modality for the correction of acne scars, but it is not always effective in all types of acne scars. How to prevent the side-effect and how to improve the treatment efficiency? Here we bring forward some principles for the application of current lasers in the skin cosmetic. As laser technology is

refined, we can ensure the optimal outcome for our patients and advance the field of cosmetic dermatology.

激光作为20世纪最重大的科技成就之一己载入史册。激光真正步入美容医学仅10年左右，然而其如同魔光，使丑变美、老变少、黑变白、糙变嫩，创造了大量令人难以置信的奇迹。美容激光的发展不仅提高了人们的生活质量、提供了大量就业机会、创造了巨大的财富，而且在一定程度上提高了人们认识自然.崇尚科学.创造奇迹的科学态度。

激光美容具有效果好、副作用小，安全性高等特点，然而激光美容中仍存在不少问题。我们应用VersaPulse多波长激光、VascuLight(PhotoDerm)强光、LightSheer半导体激光、Qunntum嫩肤仪、Sharplan10805超脉冲CO2激光、1030C超脉冲002激光Sharplan 铒激光、Sl~arplan红宝石激光、LaserscopeOrion激光、连续和脉冲式Nd：YAG激光、连续Nd：YAP激光、调Q1064／532二合一激光及ClearTouch痤疮治疗仪等治疗各种皮肤疾患上万例。本文就我们的应用体会对激光美容存在的问题进行分析并提出对策。

1．鲜红斑痣的激光治疗问题

鲜红斑痣激光治疗的最大问题是治愈率低，我们先后用过Laserscope公司的Orion激光器、ESC公司的VaseuLight强光及科以人公司的VersaPulse等设备，治疗均有效，但治愈率均未超过20％。激光治疗的疗效与病变的血管的管径大小、位置的深浅、病变所在的部位以及表皮色素的深浅等有关。一般说来，患者年龄小、皮损颜色较淡并呈粉红色、分布较弥散、病变血管间有正常组织相间隔的类型，治愈率较高；而病变颜色深、组织厚、血管密集的类型较难治疗：下肢皮损可能因重力的原因，血管易再通。

对于管径较小和较浅的血管性病变用较短的波长和脉宽治疗即