Clinic of Dermatology

The Department of dermatology and venereology utilizes the following laser types:

IPL (Intense Pulsed light) – incoherent light in the ranges between 500 and 1200 nm of the electromagnetic spectrum. Suitable for:

• Vascular lesions – teleangiectases (dilated capillaries), vascular stars, hemangioma and other vascular malformations
• Pigment lesions – brownish spots resulting from intense sun exposure, pregnancy, certain medications or age-related skin changes.
• Skin rejuvenation Skin rejuvenation – management of ageing skin.
• Scars resulting from acne, surgery, etc.
• Tattoos and other pigmentations administered in the skin.

Nd:YAG laser – Nd:Yag laser – coherent light with 1064 nm wavelenght, representing the „ golden standard“ for vascular lesion treatment:

• Dilated capillaries of the face and other body areas, hemangioma (link to vascular dermatology).
• Hemangioma and other vascular lesions;
• Leg teleangiectases dilated venous vessels with diameter below 2mm.

Carbon dioxide (CO₂) laser - emission of 10 600nm wavelength infrared light. Major indications are:

• deep laser resurfacing ;
• treatment of scars striae;
• operation of benign and malignant skin tumours without bleeding;
• removal of skin formations: xanthelasma, seborrheic keratosis, warts, etc.

Erbium laser – infrared light with 2940 nm wavelength emission. Suitable for:

• fine lines removal, radial perioral lines removal, etc.
• laser resurfacing
• treatment of scars and striae

Active FX (Lumenis Inc., Santa Clara, CA) - is a fractional CO₂ laser procedure with a dramatic effect on the skin:

• Causes immediate skin tightening.
• Reduces wrinkles and fine lines, and softens deeper frown lines.
• Noticeably improves skin tone and texture.
• Stimulates new collagen formation and plumps the skin.
• Restores the skin to a healthy youthful-looking state.

ALUMA Skin Renewal (Lumenis Inc., Santa Clara, CA) is available at the Department of dermatology. This radiowave system is suitable for:

The term "laser" – The term “laser” – (abbreviation from "light amplification by the stimulated emission of radiation") means stimulated emission of light with high energy. The first laser was created in 1959 by Maiman, who used a ruby crystal for red light emission, based upon Einstein’s concept regarding stimulated light emission suggested in 1917. Dr. Leon Goldman was the first to use the ruby laser for the treatment of skin diseases in 1963. The creation of the argon and CO₂ (carbon dioxide) lasers in the next two decades expands the dermatological indications for their application and converts dermatology into a target field for laser technology application, development and improvement. The revolutionary step in laser therapy is represented by the introduction of "selective photothermolysis" theory in the 80’s of the last century by Anderson and Parrish. The following definition summarizes its principles:

Utilization of laser energy with determined intensity and wavelength aimed at the right location with the intention to achieve the desired effect only via minimum influence upon the adjacent tissues.

What are the principles of laser action?

The therapeutic action of lasers is based on the unique properties of the laser light and its interaction with the tissues treated. The first property of the laser light is monochromatic activity or strictly defined wavelength determined by the media (solid, liquid or gas) it penetrates. Absorption of laser energy with a certain wavelength by the skin depends on the presence of certain target structures, i.e. chromofores like melanin, haemoglobin or tattoo dyes that absorb light and transform it into heat energy. The absorbed energy is measured in J/sm² and it is in direct correlation with the presence of chromofores in the area treated. For instance, the larger is the quantity of the pigment melanin in the skin, the higher is the intensity of laser action. The second property of laser light determines the possibility of focusing a narrow ray of light with high intensity onto a very small skin area; it can also cut like a surgical knife or provide precise tissue destruction.

What are the laser types?

1. Continuous wave length lasers (CW – continuous wave) – laser systems that emit continuous light ray, which leads to destruction of the tissue chosen. For example, CW CO₂, argon etc., implemented in dermatological surgery mainly for the treatment of various benign and malignant formations; the bigger risk of side effects on the surrounding skin quite often leads to their substitution by pulsed laser technologies in the recent years.
2. Pulsed laser systems that emit high-energy laser light (not continuous) via short impulses with relatively long intervals between them. This option allows using higher energy while trauma to the surrounding skin is minor. For example, IPL (Intense pulsed light) systems, which expanded their indications recently thanks to these advantages and appeared to be the most desired and applicable laser technology in the world – leading laser centers.

Laser systems can also be divided into long pulsed (LP): Pulsed dye laser (PDL) and short pulsed: QS ruby, alexandrite, neodymium: yttrium-aluminum-garnet (Nd:Yag) laser, etc.

Separate lasers have different clinical indications dependent on their physical parameters and the choice of the most appropriate laser system depends on the demanded therapeutic effect. For instance, IPL technology or the combination between IPL and Nd:Yag laser is essential for undesired pigmented spots or dilated capillaries removal. This combination has established itself in the recent years across the world as a method for an extremely effective and safe procedure that leads to excellent clinical outcome, the so-called photorejuvenation.

The Department of dermatology at Military Medical Academy – Sofia is the only dermatological center in the entire country, which utilizes the most effective and widespread last generation laser technologies:

• CO₂ laser – Ultra Pulse Encore CO₂ Laser System – Lumenis.
• IPL (Intenså pulsed light) - Lumenis OneTM system.
• Nd:YAG laser - Multi-Spot Nd:YAG laser – Lumenis.
• Erbium-laser.

These systems allow treatment of extremely broad spectrum of dermatological diseases and conditions, aesthetic and cosmetic problems. The top technology equipment is handled by excellently trained specialists, which confirms the postulate that lasers are not a miracle – they are just means for its achievement through correct laser selection, working on the right place, in the right time and managed by skilled hands!

Laser systems can be generally divided according to their principle of action and clinical effects into:

1. Ablative lasers – they break the integrity of the superficial skin layers (CO₂, Erbium laser).
2. Non-ablative lasers – they achieve therapeutic effect not by breaking the integrity of the skin, but through the biologic action of the light itself (IPL, Nd: Yag, etc.).