IPL: The light-based fountain of youth

This month I thought I’d focus on how one of my favorite treatments to administer works to improve your skin: Intense Pulsed Light (IPL). IPL goes by several other names, including broadband light (BBL) and photofacial, or fotofacial.

What Is Intense Pulsed Light (IPL)?

IPL is not a laser, but rather a broad spectrum of light in the visible to the near infrared portion of the electromagnetic spectrum used to selectively reach targets in the skin and eliminate/lessen them to improve overall appearance. The most common targets are redness/blood vessels, brown spots from sun damage, and pigmented (non-white/non-blonde) hair, but improvements in wrinkles and pore size have also been observed over time with repeated treatments. By using different filters, shorter wavelengths of energy are eliminated to allow IPL to treat the various targets in the skin. Because IPL selectively damages its target, surrounding (non-target) structures remain undamaged and may even show beneficial changes on a cellular level contributing to the global improvement in skin seen after multiple IPL treatments. One of the amazing qualities of IPL is the ability to achieve significant improvement in skin with minimal downtime.

Does IPL Work & How Many Treatments?

Numerous studies have shown some exciting results from IPL. After four IPL treatments done at 3-week intervals, dermatologist Dr. Bitter found that all facets of sun-induced aging changes, including wrinkles, skin texture, irregular pigment, pore size, and blood vessels, improved in more than 90% of subjects. (1) The short and long term benefits are the reason I encourage all of my patients who have completed an IPL series* to continue with maintenance treatments 1-2Xs/year. In one study, participants who first underwent an IPL series and then continued with IPL treatments at least once yearly for a minimum of 5 years (up to 11 years) looked (a median of) 10 years younger than their current age! (2) “The results of this study demonstrate that patients who maintain a regular annual or biannual regimen of BBL treatment can both reduce and delay the long-term signs of skin aging such as photodamage, telangiectases, fine lines and wrinkles, and skin laxity in a natural- looking way.” (2, emphasis mine) The improvement in fine wrinkles is likely attributed to IPL’s dose-dependent effect on dermal fibroblasts (collagen-making cells) and increase in collagen and growth factors. (3) IPL has been found to influence the expression of thousands of genes so they are more like those seen in younger skin thereby making aged skin look younger. (4) These and other studies indicate that the improvements we see with our eyes appears to be explained by rejuvenation on a molecular level—absolutely fascinating!

What is IPL Used For?

My main use of IPL is photorejuvenation to treat sun damage (sun spots and blood vessels) with the added benefit of improvements in skin texture and fine lines. I also use it for other forms of discoloration, rosacea, angiomas, and hair reduction. As with laser hair reduction, IPL only works on pigmented (not blonde/gray/white) hairs, multiple treatments are needed, and hairs become finer and more sparse over treatment sessions. IPL can be done on virtually any area of the body, though the face tends to be the most commonly treated. Each pulse feels somewhat like a rubber band pop with fairly immediate relief due to the ice-cold crystal tip on treated skin and the cooling roller applied to surrounding skin. The face (sun damage, hair) and bikini (hair) tend to be more sensitive areas, but even treatment to those sites is generally well-tolerated, especially if patients utilize the optional laughing gas available at VibrantSkin.

How Safe Is IPL?

Despite all of the benefits of IPL, there are potential dangers, including scarring, burns, discoloration (lighter or darker), and worse. Having IPL treatments done by a board certified dermatologist (BCD) can help minimize your risk of adverse events. Many people do not realize that in Oklahoma, it is illegal for a non-physician to perform laser/light-based treatments without the patient first being assessed in person by a physician or physician assistant. (5-8) Thereafter, treatments can be delegated, but only by a physician (i.e., a physician assistant cannot delegate a laser treatment to a nurse, etc.) and that delegated treatment must be done within physician-specified parameters.

When Should IPL be Used?

Not all brown spots should be treated with IPL, and it often takes the trained eye of your BCD to differentiate between a plain ole’ sun spot and a melanoma, for example. I’ve recently had three patients come to me requesting IPL, laser or cryosurgery (freezing with liquid nitrogen) for treatment of brown spots on their faces. After close examination, all three spots raised my suspicion for melanoma. My dermatoscope—the special magnifying tool I use when doing skin checks—was extremely helpful in identifying concerning features leading me to obtain samples of each lesion for further testing and all three proved to be early melanomas. I’ve also recently excised another subtle facial melanoma that I diagnosed by dermoscopy. All of the above examples are ones that did not fit the classic examples of melanoma that have multiple colors or very dark hue. All four were very light to medium brown and could easily be mistaken for sun damage spots. There are multiple reports in the medical literature of delayed diagnosis of melanoma or melanoma metastasis (spread internally) after the original melanoma was thought to be benign (e.g., sun spot or mole) and treated with laser/light. (9,10)

Just like not all spots can be treated with IPL, not every person is a candidate for this procedure. Darker skin types can suffer severe injury from IPL. It can also worsen melasma thus should be either avoided or used for that condition only with extreme caution and extensive experience. Proper patient selection is key to minimize risk of temporary or permanent injury.

Appropriate eye protection during IPL treatment is also critical. Lasers and lights used to treat the skin can cause blindness if inadvertently directed towards the eye or if the beam reflects off of glass or other shiny surface and into the eye. IPL targets pigment, which is also deep in the retina of the eye as well as in the uveal tract. This is why EVERYONE in the treatment room must have on protective eyewear. Not all eyewear is equal—different devices require different protection. Laser and light operators must know the spectrum of the devices they are using and be certain to select the correct protection for the device being used.

So that’s the scoop on IPL! I don’t think I’ll ever tire of seeing the positive changes that occur with this versatile treatment. With its minimum downtime, patients can immediately return to work or play, put on make-up if desired, and enjoy normal activities with minimal restrictions. Intrigued by the concept of IPL? Come see me to learn if it’s the right option for you!

Kesha Buster, MD FAAD (board certified dermatologist)

P.S. I want to invite you to suggest blog topics you might be interested in reading about this year. Email me at info@vibrantskintulsa.com with subject line “blog idea” and we’ll add the most interesting and popular requests to our list!

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