Lasers in Dermatological Practice Kabir Sardana, Vijay K Garg
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1LASERS in Dermatological Practice2
3LASERS in Dermatological Practice
Editors Kabir Sardana MD DNB MNAMS Professor Department of Dermatology and STD Maulana Azad Medical College New Delhi, India Vijay K Garg MD MNAMS Director-Professor and Head Department of Dermatology and STD Maulana Azad Medical College New Delhi, India Forewords Ganesh S Pai B Krishna Rau
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Lasers in Dermatological Practice
First Edition: 2014
9789351523000
Printed at
5Dedicated to
My colleagues, friends and foes, the last of which goad us to better ourselves
constantly……
My wife Dr Supriya, who helps me to keep the balance between family and
academics
My daughter Zoya, who is the ‘zing’ in my life
My parents, Mrs Amba Sardana and Major General Sardana who have
instilled discipline in my life
and
Lastly, the Department where over the years we have honed the skills in laser
intervention
—Kabir Sardana
My family and friends
My wife Mrs Manju Garg, who has stood by me through times of strife
My son Devansh, who is pursuing his MBBS
and
My daughter Dr Ekta, who is a dentist
—Vijay K Garg
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7Contributors 9Foreword
Lasers have moved from the fringe of dermatology to a more centrist path over the past decade. Fifteen years ago, when lasers trickled into our country, they were considered to be exotic and perhaps accessible to a select few. Cosmetic dermatology and lasers have grown by leaps and bounds and that necessitates that they are absorbed in the mainstream.
With close to half of the dermatologists now owning or having access to lasers, it is important that our younger generation of dermatologists have access to good practical textbooks as well as high quality equipment. This book, Lasers in Dermatological Practice is best suited to educate our specialty about the perils and pitfalls of using lasers.
Indian skin is unique since it comes commonly in 3 types—IV, V, VI. Parameters will therefore vary depending on the skin types, a dilemma that western books do not address. Postinflammatory hyperpigmentation will vary in each skin type and even show variation among patients in a single skin type. Such unpredictability and perplexing results are a cause of anxiety in a cosmetologist at an inflexion point in his career. A comforting thought is that our patients, except for a miniscule minority, are forgiving and compliant. Most cases of tissue damage by laser will heal over time, nature coming to our rescue. Our patience and reassurance will comfort patients in the interim period.
In clinical dermatology, we have a chance to assess, judge and treat patients. If there is an error of management, we can apply a midcourse correction and modify therapy. Unfortunately, this is not true of lasers. A mistake made, a poor assessment, using more or less power than required can lead to laser burns and scarring. If it is on the face, as it is most of the time, the consequences are not difficult to portend. Since there is no second chance to repair damage, it is important to understand the basics of lasers and the specifics of equipment much like reading a car manual before driving your new car. This book does both and will hopefully lead to confident cosmetologists and happy patients.
Ganesh S Pai md dvd faad
Medical Director
Derma-Care Skin and Cosmetology Center, The Trade Center
Director-Professor, Department of Dermatology
KS Hegde Medical College, Deralakatte
Mangalore, Karnataka, India
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11Foreword
I thank the authors for giving me the opportunity to write the Foreword to this excellent book, Lasers in Dermatological Practice. The editors along with the co-authors have put down their vast experience in the use of laser in various dermatological conditions. It is a book of international standards and, in particular, reference to the application of lasers in brown and dark skin patients. Basics of laser in relation to skin lesions are well-written.
The use of the different lasers in different dermatological lesions and the step-by-step approach to each and every lesion is superb. The practical tips to avoid wrong outcome is well-documented. The use of non-laser energy sources in dermatological practice is very illuminating. The references at the end of each chapter are apt and to the point.
The chapter on medicolegal aspects is pertinent and informative. On the whole, it is the end result of the vast experience over the years that the editors have acquired to write this book. I am confident that this book will find a place in all dermatologists library.
B Krishna Rau
ms frcs (eng and edin) frcs (thailand) (hon) fiams facg fics figsc
Professor-Emeritus, Dr MGR Medical University
Honorary Fellow, American Surgical Association
President, World Federation of Society for Laser and Surgery Medicine
Chennai, Tamil Nadu, India
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13Preface
The genesis of this book arose from the common mechanistic approach where we learn which buttons to push, in courses provided by the more reputable device manufacturers just after a laser is purchased. This approach is foolish beyond words, and can harm patients, and worse create medicolegal hazards.
There are some excellent books that we have referred to but most of them deal with technologies that are nice to hear but too expensive to use in India. Our book was initially planned as a companion to the hands on workshop where the nitty gritty was left out while the topic in focus was discussed. Thus the first edition was done with the help of Sun Pharmaceuticals. This edition is the combined effort of Abbot and the vision of Shri Jitendar P Vij, who convinced us to make it an elaborate yet compact book.
The book answers the three basic questions, what to do, why to do it and how to do it? But our basic target is the dermatologists who need a step-by-step approach to the technology commonly used and not the laser that a speaker in most conferences uses, which as a thumb rule is expensive, the reason why the company sponsors the talk in the first place! Though the FDA gives clearance of a device for a particular labeled indication, this cannot be taken as any assurance that it will work safely and effectively enough to satisfy the patients. Tragically, it may not be an understatement that a majority of lasers bought in this country are not US FDA approved in the first place!
The book will also look at some questions that we rarely ask. What is the histological depth of fractional lasers? Which type of atrophic scar actually responds? Is Fr CO2 superior to Er:Glass? And many others.
As the field of cosmetic intervention usually encompasses indications where novel non-laser technologies are used, we have covered radiofrequency, focused USG, plasma resurfacing and LED.
The book is planned in such a way where the commonly performed procedures are discussed which gradually move on the advanced techniques. Practical aspects like medicolegal hazards and pearls are discussed in the latter half of the book. Some very useful information is provided in the appendices.
Our contributors are largely those who are experts in their field of interest. Our own work spanning over 8 years, with almost 5,000 procedures helped us to bridge the gap between theory and practice.
But this is not a “Cook Book” and only a guide on the best approach is provided. Individual laser parameters can vary, thus there is no substitute for hands-on training, which cannot be obtained in this book or sitting in a lecture hall more so when there are hundreds sitting in it!
Hope you like the effort. More will follow soon…
Kabir Sardana
Vijay K Garg
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15Acknowledgments
We would like to thank our faculty residents and students of the department some who have left to join other institutions, for their role in establishing and developing the Laser Clinic at Maulana Azad Medical College (MAMC), New Delhi, India.
Special thanks to Dr Vijay K Garg, Director-Professor and Head, Department of Dermatology and STD, MAMC, who through his administrative acumen, managed to get the lasers. He has given me great support and has served as a mentor throughout my professional career. His guidance and encouragement over the years have influenced my efforts.
A special thanks to the team at M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, especially Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Managing Director), for latching on to the project, Mr PN Venkatraman (Vice President-International), Mr Shashikumar Sambhoo, for handling the publicity and sales and Mr Tarun Duneja (Director-Publishing), Mr Subrata Adhikary (Commissioning Editor), Mr Lalit kumar (DTP Operator) for helping with the deadlines.
A big thanks to our contributors, some of whom who have worked on their chapter on a one month deadline! Each of them is an expert in their field.
Dr Simal Soin, Dr Shahin Nooreyezdan, Dr Inder Raj S Makin and Dr Vivek Nair have worked on such a deadline. Dr Inder Raj S Makin has also been kind enough to review two chapters for us and his comments have been an asset to the chapters.
Dr Khandpur and Dr Anil Agarwal have also contributed after taking out time from their busy schedule. Dr Atul M Kochhar who is also the Purchase Officer at our Hospital has given nuances of buying lasers.
A big thanks to Dr Antje Katzer (Ascepelion), for letting us use the images of the company's devices.
And lastly, our tributes to the countless patients who have taught us dermatology and helped us to learn and relearn lasers!
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Real knowledge is to know the extent of one's ignorance
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