Overview of Intense Pulsed Light (IPL) Therapy
Intense Pulsed Light therapy – or IPL for short – was first created by Doctors Goldman, Fitzpatrick, and Eckhouse in 1992 as a way to treat tiny, dilated blood vessels on the legs, which are known as telangiectasias. Early tests on rabbit veins proved that IPL could heat and close these blood vessels while minimizing bruising and damage to the overlying skin. IPL devices received approval from the U.S Food and Drug Administration (FDA) for use in 1995, and since then, they have been continually improved and made more affordable.
The IPL device works in a unique way. It uses flashlights and bandpass filters to produce pulsed light of different wavelengths (colors), durations, and energy levels. This flexibility allows IPL to be used in treating various skin conditions.
IPL therapy is safe and effective in treating skin disorders related to pigmentation (color) and blood vessels. It can also remove unwanted hair and reduce signs of sun-induced skin aging. Currently, IPL is a vital tool in the field of dermatology and is often used to address a wide variety of cosmetic and functional skin concerns.
Anatomy and Physiology of Intense Pulsed Light (IPL) Therapy
Intense Pulsed Light (IPL) technology works by using a lamp that gives off many different colors of light, ranging from 400 to 1400 nm. This is quite different from laser light, which only has one color or wavelength, and all the light waves run parallel and in phase with each other. The beauty of IPL is that it can be used to treat a variety of skin types and conditions because it has a range of light colors.
Another great feature of IPL technology is that we can filter out certain wavelengths of light that we don’t want to use on your skin. For example, we can adjust the machine to filter out shorter waves like ultraviolet light which is harmful, and let through the longer, safe infrared light. Ultimately, this allows us to customize the treatment specifically for you.
The way IPL works on the skin is quite fascinating. The light from the IPL machine gets absorbed by the skin and turns into heat. Different parts of your skin, such as red blood cells (hemoglobin), water, and skin pigment (melanin), absorb this light and heat up. This heat then damages these parts, causing them to break up, which is how conditions like unwanted hair or skin discolorations are treated. It’s like a targeted heat-treatment for your skin, and it’s all based on this process called selective photothermolysis.
Why do People Need Intense Pulsed Light (IPL) Therapy
The Food and Drug Administration (FDA), the government agency responsible for ensuring the safety and effectiveness of treatments, has given the green light for Intense Pulsed Light (IPL) therapy to treat various conditions. These include:
* Telangiectasias – Tiny, broken blood vessels just under your skin’s surface.
* Photorejuvenation – A skin treatment that uses lasers, intense pulsed light, or photodynamic therapy to treat skin conditions and remove effects of photoaging like wrinkles, textural changes, and discolorations.
* Facial wrinkles – Lines and creases that develop on your face as a part of the natural aging process.
* Hyperpigmentation – Darker patches on the skin caused by excess melanin production.
* Lentigines – Small tan, brown, or black markings often known as liver or age spots.
* Ephelides – Also known as freckles, appearing as light brown spots on your skin.
* Melasma – A common skin problem causing brown to gray-brown patches on the face.
* Rosacea – A skin condition that leads to redness and visible blood vessels in your face.
* Acne vulgaris – The common form of acne, which includes different types of pimples.
* Poikiloderma of Civatte – A condition causing reddish-brown patches with visible blood vessels and changes in skin texture.
* Port-wine stains – A birthmark appearing as a pink or red patch on the skin.
* Hemangiomas – A birthmark that appears as a bright red birthmark that shows up at birth or in the first or second week of life.
* Leg veins – Varicose or spider veins visible under the skin.
* Venous malformations – Abnormalities in the veins causing them to stretch and become larger.
* Removal of unwanted hair – Used for people who prefer a less hairier skin.
In addition to these treatments, Intense Pulsed Light therapy has also been recently introduced in eye healthcare. Specifically, it is used for managing dry eye disease which is due to malfunctioning of the meibomian glands, the tiny oil glands which line the margin of the eyelids.
When a Person Should Avoid Intense Pulsed Light (IPL) Therapy
IPL, or intense pulsed light treatments, are usually safe and easy to handle. However, there are a few instances when it’s best to avoid IPL. For example, if you have a recent sunburn or if you are pregnant or breastfeeding, it’s not recommended.
Also, IPL treatments can sometimes trigger outbreaks of the herpes simplex virus (HSV). This is similar to what can happen during laser treatments as well. The outbreaks are caused by a brief warming effect that reactivates dormant HSV in a group of nerve cells known as the trigeminal ganglion.
If you’ve previously had HSV, starting preventative antiviral therapy (with drugs like acyclovir, valacyclovir, or famciclovir) might be a good idea. Usually, this treatment should start the day before your IPL session and continue for up to 2 weeks afterward.
Equipment used for Intense Pulsed Light (IPL) Therapy
Intense Pulsed Light (IPL) therapy is a non-invasive treatment that helps skin in many ways. It works by releasing light at specific wavelengths to treat different skin issues. Here’s what the science behind IPL therapy involves: wavelength, pulse duration, how much IPL light energy penetrates your skin (fluence), and the size of the light beam (spot size).
Wavelength
The IPL device emits light with different wavelengths, typically between 400 to 1400 nm. The type of light that reaches a patient’s skin can be adjusted using filters. This way, certain parts of the skin can be targeted specifically. The skin contains molecules that absorb specific wavelengths of light, converting it into heat.
It’s essential to make sure that the light doesn’t get absorbed by the wrong parts of the skin, leading to ineffective treatment. For instance, melanin (which gives our skin color) in the topmost layer of the skin may absorb this light, preventing it from reaching deeper layers of the skin.
This is particularly important when IPL therapy is used on darker skin, as altering the wavelength to penetrate deeper may help safely treat underlying skin layers without changing the skin’s color. In contrast, for light skin types, shorter wavelengths effectively treat pigmented skin lesions.
Pulse Duration
The duration of each light pulse is tailored based on its target in the skin. Each part of the skin has a specific measure of time at which it can be heated and cooled (thermal relaxation time). The aim is to heat the target area and let it cool down to a safe temperature before the next light pulse is administered. This minimizes the chances of scarring or lightening of the skin. Specifically designed IPL devices can either emit a single pulse or multiple staggered pulses to accommodate this.
Fluence
Fluence refers to the amount of IPL light energy delivered to each unit area of the skin. A high fluence may be used if targets are located deep within the skin or if they don’t easily absorb light. However, side effects tend to increase in frequency at higher fluences, especially in darker-skinned individuals. Cooling devices are used to offer a higher safety profile by letting thermal energy penetrate deeper without damaging the topmost skin layer.
Cooling systems
Cooling systems ensure the safety of the skin and allow the IPL light to effectively reach deeper spots in the skin. They can be built into the IPL device or applied externally such as ice packs, air cooling, or cold gel on the skin before treatment. They help to reduce discomfort and lower the risk of skin damage.
Spot Size
The spot size refers to the diameter of the IPL light beam that comes out from the device. A bigger spot size lets the light penetrate deeper, scattering it less and making it more effective. If the spot size is smaller, the energy needed to target deeper layers of the skin will be higher. This can be controlled using interchangeable pieces on the IPL device.
Who is needed to perform Intense Pulsed Light (IPL) Therapy?
IPL (Intense Pulsed Light) treatments, which includes several different types of laser procedures, are usually performed in a clinic that you can walk in and out of on the same day. Either a doctor or surgeon can do them, but often, it’s a healthcare provider like a physician assistant or a nurse practitioner who carries out the treatments. In some areas, even regular nurses are allowed to do laser and IPL treatments. Regardless of who does the treatment, there is always a doctor, such as a skin specialist or plastic surgeon, as part of the team. This way, there’s an experienced medical professional on hand to quickly deal with any issues that might come up during the procedure.
Preparing for Intense Pulsed Light (IPL) Therapy
Before starting Intense Pulsed Light (IPL) treatment, the patient is taken to a private room where they can comfortably expose the skin area that needs the treatment. This room needs to have enough space for the IPL machine, and often a special power outlet, which might not be available everywhere.
A cold gel is applied to make the treatment more comfortable for the patient and help the light energy from the IPL machine reach the skin effectively.
Protecting the eyes is also vital because the intense light from the IPL machine can harm the eyes, especially the part called the retina which helps us see. Therefore, both the patient and the person providing the treatment need to wear eye protection. The eye shields should not be moved during the treatment to avoid any accidental injury to the eyes.
Just like with any other treatment, it’s crucial to discuss and understand what to expect before receiving IPL treatment. The provider should explain what result is likely, how many treatments might be needed to get the desired result, and precautions to take after the treatment, like staying out of the sun. Potential complications such as changes in skin color, redness, crusty skin, blisters, and scarring should also be discussed. After this discussion, the patient will give their informed consent to go ahead with the treatment.
How is Intense Pulsed Light (IPL) Therapy performed
IPL (Intense Pulsed Light) devices work differently from lasers. They generate a kind of light that’s mixed (polychromatic and noncoherent) and covers a larger number of wavelengths. This broad range allows us to adjust their intensity (fluence), pulse duration, spot size, and specific filter wavelength. This adaptability makes IPL devices versatile as they can treat many types of skin conditions and types.
To get the full effect of IPL treatment, you usually need multiple sessions. It’s typically between 3 to 6 treatments, scheduled every 2 to 4 weeks. The effect adds up over time, so the more frequent the treatments, the better the results.
Some conditions may need more treatment sessions than others. For instance, if a skin blemish, or ‘lesion’, has more pigmentation or is located deeper within the skin, it might need more attention since it’s harder to reach.
Compared to laser treatments, one of the main advantages of IPL is a shorter recovery time after treatment. It’s also generally less expensive in terms of the cost of the equipment. That said, IPL devices can be heavier due to the lamp and cooling mechanism incorporated into the handheld piece. It’s also worth noting that a cold gel is applied to the skin before treatment which can sometimes lessen the visibility of immediate reactions on the skin.
When using IPL devices, choosing the correct filter is crucial for achieving the desired results and preventing complications. Most IPL devices come with default settings designed to ensure safe treatments and minimal risk of complications. Even though using these conservative settings might not give the most effective results, we recommend starting treatments with these settings.
The different filter settings or wavelengths allow for varying levels of skin penetration. For example, shorter wavelengths penetrate less deeply than longer ones. The chart below shows some common settings and uses for IPL filters:
IPL Filter Settings:
– Acne: 420-430 nm
– Pigmented Lesions: 515-530 nm
– Vascular Lesions: 560-590 nm
– Rejuvenation: 570-690 nm
– Hair Removal: 640-800 nm
Possible Complications of Intense Pulsed Light (IPL) Therapy
Intense Pulsed Light (IPL) treatment doesn’t usually have severe side effects, but some people might experience pain, skin redness, swelling, blisters, blood spots, dryness or changes in skin color as well as hair loss or unusual hair growth. In rare cases, it might cause scars or skin infections. These reactions might be more common if the person performing the treatment is not well-trained or uses the wrong equipment settings, giving off too much energy and causing heat damage.
The use of IPL for people with darker skin needs to be approached with extra caution, because the wavelengths of light absorbed by melanin (the pigment that gives skin and hair their color) can cause changes in skin color. But, improvement in IPL devices and cooling techniques has allowed those with darker skin to undergo treatment with fewer risks of side effects. After treatment, your skin might react for about 2 to 48 hours, depending on factors like the intensity of light pulses, duration of pulses, location of treatment, as well as your skin thickness and color.
Suppose you are getting an IPL treatment for hair removal. In that case, you might notice something called paradoxical hypertrichosis, which is when fine, dark hair starts growing in the areas near where you had the treatment, especially in people with darker skin tones. Although the exact reason for this isn’t fully understood, it could be because the IPL process stimulates hair growth cells or triggers the release of certain substances in your body that convert finer hairs into thicker hairs. If this happens to you, your doctor might adjust the intensity of the treatment, frequency of treatments, cooling method, or change the type of laser used. Also, a topical cream named eflornithine might be applied to slow down hair regrowth after treatments.
What Else Should I Know About Intense Pulsed Light (IPL) Therapy?
Intense Pulsed Light (IPL) is a technology that uses powerful light to treat many skin conditions. Since its development in the 1990s, IPL has improved significantly with brighter lights, filters, and cooling systems. These enhancements have made IPL an excellent tool for treating skin conditions like: sun spots and freckles; blood vessel-related conditions such as spider veins, birthmarks, and other skin growths; as well as for procedures like hair removal and healing sun-damaged skin.
Modern IPL devices can also target specific areas with greater precision and have less light scattered in the process. This makes the treatment more precise and effective.
