Part 2- IPL
Among other treatments and modalities, Dermal Clinicians study lasers, IPL technology quite extensively. So, what is IPL?
IPL, or Intense Pulsed Light, is a non-ablative, non-invasive, non-laser, high-intensity
broadband light source. IPL first made its introduction in the 1990’s, as an alternative
to traditional laser technologies. Dissimilar to lasers, to exert its clinical effects IPL
uses polychromatic, non-coherent and non-collimated broad spectrum pulsed light at
wavelengths between 400nm and 1200nm.
How does IPL work?
In IPL systems, light pulses are generated by bursts of electrical current passing
through a xenon gas-filled chamber. The lamp output is then guided toward the far
end of the handpiece, to then subsequently discharge the energy pulse onto the
skins surface via a sapphire or quartz block. IPL light pulses have a precise duration,
intensity and spectral distribution to enable controlled and confined energy transfer
to tissues. The workings of IPL systems are founded on the basis that certain targets
for energy absorption (chromophores) are capable of absorbing energy from the
broad spectrum of light wavelength. The three main chromophores found within the
human skin are haemoglobin (oxy- and deoxy-), water and melanin. All of these have
broad spectrum absorption peaks of light energy, which enables them to be targeted
by a range of specific wavelengths of light. IPL devices use dichroic or “cut off” filters
to render the device more specific and therefore selectively target various desired
chromophores, depending on the condition being treated. IPL technologies, like
lasers, employ the principle of selective photothermolysis to achieve successful
clinical outcomes. This is where photons, or light energy, is absorbed by the targeted
chromophore. This transfer of energy to the epidermal or dermal target structures
generate heat and a thermal reaction to subsequently destruct the target, while
sparing adjacent tissues and cells. IPL devices also use cooling systems to aid in
epidermal preservation, these may be; cryogen spray, contact cooling or forced
refrigerated air.
What are the advantages of IPL?
The use of IPL has become increasingly more conventional due to its many claimed
advantages. These include:
Flexibility and versatility for its operators, whereby the device can be configured and manipulated to target multiple chromophores over a large skin area in a single pulse. Though, this can also be seen as a serious limitation for non-experienced clinicians due to the potential for incorrect parameter selection thereby resulting in serious side-affects for patients
Swift procedure for clinicians, this is owing to the larger spot size which allows for the swift treatment of large anatomical areas
Less complex
More cost-effective
Minimal patient downtime
What are the general clinical indications for IPL?
IPL devices are employed by many practitioners to treat numerous skin anomalies
for both aesthetic and therapeutic purposes. These include:
Vascular Lesions (Telangiectasia, Capillary malformation, Poikiloderma of Civatte, Venous malformations, Infantile hemangiomas, Birthmarks, Port Wine Stains (PWS), Rosacea, Erythema). The IPL light targets the haemoglobin within the blood, this then generates a thermal reaction and the transfer of heat to the vessel wall to instigate coagulation and vessel wall closure and collapse.
Pigmented lesions (Ephelides, Solar Lentigines, Becker’s Naevus): The IPL light targets the melanin within the lesion, this then generates a thermal reaction and thereby rapid differentiation of keratinocytes, resulting in the upward transfer of melanosomes along with necrotic keratinocytes, causing their elimination. A micro crust then forms on the skins surface which in time is sloughed off.
Hair removal: IPL light targets the melanin within the hair shaft, follicular epithelium and the hair matrix, this then generates a thermal reaction and thus destruction and denaturation of the hair follicle, preventing further growth.
Ageing: IPL light targets water within the skin, this then generates a thermal reaction and heats the collagen fibres, leading to their contracture.
Seborrheic Keratosis
Hypertrophic and Keloid scarring
Acne vulgaris
Hidradenitis suppurativa
What are the risks and complications associated with IPL? And what are the current safety regulations of IPL devices within Australia?
IPL is generally considered a safe procedure, and while common side effects such
as; pain, erythema, oedema and bruising are considered normal, the delivery of IPL
procedures can still come with varying degrees of risks and complications, such as:
Blistering and burns
Hypopigmentation (thermally induced destruction of melanocytes)
Post Inflammatory Hyperpigmentation (PIHP) (thermally induced stimulation of melanin from the epidermal melanocytes)
Eye damage
In severe cases, scarring
While these risks and complications are rare, the majority of the cases are due to
unqualified and untrained operators using incorrect parameter and setting selections.
Operators without the correct training and education do not have an accurate
understanding of the risks and complications involved in IPL procedures, and they
may be occupying equipment that is sub-standard or poorly maintained. What’s
more, presently within Australia, only Tasmania require licensing for the employment
and operation of IPL devices. All other states within Australia currently do not have
licensing requirements, regulation or legal frameworks pertaining to the operation of
these devices. Therefore, in order to ensure the safe and effective treatment of
aesthetic and therapeutic IPL procedures, it is crucial that consumers seek
educated, qualified, and trained Dermal Clinicians.
References
Alster, T., & Husain, Z. (2016). The role of lasers and intense pulsed light
technology in dermatology. Clinical, Cosmetic and Investigational
Dermatology, 29. https://doi.org/10.2147/ccid.s69106
Ash, C., Town, G., Whittall, R., Tooze, L., & Phillips, J. (2017). Lasers and intense
pulsed light (IPL) association with cancerous lesions. Lasers in Medical
Science, 32(8), 1927-1933. https://doi.org/10.1007/s10103-017-2310-y
Babilas, P., Schreml, S., Szeimies, R., & Landthaler, M. (2010). Intense pulsed light
(IPL): A review. Lasers in Surgery and Medicine, 42(2), 93-104. https://doi.org/10.1002/lsm.20877
DermNet NZ. (2020). Intense pulsed light therapy. DermNet NZ – All about the skin
Goldberg, D. J. (2012). Current trends in intense pulsed light. The Journal of Clinical
and Aesthetic Dermatology, 5(6), 45–53.
Lasers, IPL devices and LED phototherapy for cosmetic treatments and beauty
therapy. (2020). health.vic. https://www2.health.vic.gov.au/public-
health/radiation/lasers-ipl-led-phototherapy
New laser and IPL regulations proposed. (2015, November 25). Aesthetic Medical
Practitioner. https://aestheticmedicalpractitioner.com.au/news/new-laser-and-
ipl-regulations-proposed/
Paasch, U., Schwandt, A., Seeber, N., Kautz, G., Grunewald, S., & Haedersdal, M.
(2017). New lasers and light sources - old and new risks? JDDG: Journal der
Deutschen Dermatologischen Gesellschaft, 15(5), 487-
Piccolo, D., Di Marcantonio, D., Crisman, G., Cannarozzo, G., Sannino, M.,
Chiricozzi, A., & Chimenti, S. (2014). Unconventional use of intense pulsed
light. BioMed Research International, 2014, 1-10. https://doi.org/10.1155/2014/618206
The Royal Australian College of General Practitioners. (2017). Navigating the
disparate Australian regulatory minefield of cosmetic therapy. https://www.racgp.org.au/afp/2017/september/navigating-the-
disparate-australian-regulatory-minefield-of-cosmetic-therapy/
Ullmann, Y., Elkhatib, R., & Fodor, L. (2011). The aesthetic applications of intense
pulsed light using the lumenis M-22 device. LASER THERAPY, 20(1), 23-
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