Energy for the Skin : Effects and Side-Effects of Lasers, Flash Lamps and Other Sources of Energy

Energy on the skin has revolutionized medicine: in the last 25 years laser and IPL devices have made completely new medical treatment concepts possible, with considerable therapeutic success. The rapid technical advances in energy-based instruments require continuous training for attending physicians. This book presents all the available energy-based systems for the treatment of cutaneous diseases, including a wide range of laser applications, IPL and energy-based devices such as the lightning lamp-pumped pulsed dye laser, solid state lasers like neodymium-doped yttrium aluminum garnet (Nd YAG) laser, quality switched ruby laser, erbium-doped yttrium aluminum garnet laser (YAG) and CO2 laser, as well as radio frequency and high-intensity focused ultra sound, photodynamic therapy and more. The translation was done with the help of artificial intelligence (machine translation by the service DeepL.com) and a subsequent human revision by original chapter authors, editor and publisher was perfomed to fine-tune and update the content. After discussing the history of the laser, the first part of the book focuses on laser therapy in dermatology and aesthetic medicine, including side effects, complications and treatment errors. It also examines the qualitative standards and legal aspects, from therapists' qualifications to patient education and the maintenance of the equipment. In addition, it addresses safe and effective energy applications for hemangiomas, skin cancer precursors and rosacea. The book also features chapters on patient preparation, medical history and photographic follow up, as well as skin analysis, cooling techniques, light protection and the maintenance of laser devices. Further, it discusses cosmetic topics such as tattoo removal, photo hair removal, scars and stretch marks, hair transplant, body contouring, hyperhidrosis, and aesthetic plasma medicine. Written by leading international exerts, each contribution includes suggestions for further reading, making the book a valuable resource for beginners and experts alike. At the same time, its easy-to-follow, didactic style means that it is also suitable for university courses and seminars. This book is a translation of an original German edition. The translation was done with the help of artificial intelligence (machine translation by the service DeepL.com). A subsequent human revision was done primarily in terms of content, so that the book will read stylistically differently from a conventional translation Foreword by Professor Metelmann Foreword by Doctor Strömer and Doctor Schlette Foreword by Professor Kunte Preface to the First Edition Acknowledgment Contents Contributors About the Publisher Curriculum Vitae Dr. med. Gerd Kautz Abbreviations Part I: Theoretical Part 1: The History of the Laser 1.1 Stimulated Emission 1.2 MASER (Microwave Amplification by Stimulated Emission of Radiation) 1.3 LASER (Light Amplification by Stimulated Emission of Radiation) 1.4 Laser in Dermatology and Aesthetic Medicine Fractionated Laser Therapy Picosecond Laser Intense Pulsed Light (IPL) 1.5 Historical Overview Conclusion Suggested Reading 2: Laser Therapy in Dermatology and Aesthetic Medicine: Side Effects, Complications, and Treatment Errors 2.1 Side Effects and Complications Neodymium-Yttrium-Aluminum-Garnet (Nd:YAG) Laser (1064 nm) Ruby Laser (694 nm) Alexandrite Laser (755 nm) CW Argon Lasers (488 and 514 nm) Pulsed Dye Laser (577/585/590/595/600 nm) CO2 Laser (10,600 nm) Erbium:YAG Laser (2,940 nm) Copper Vapor/Copper Bromide Lasers (511/578 nm) Krypton Lasers (520, 530, and 568 nm) 2.2 Contraindications to Laser Therapy Nevus Cell Nevi Chloasma 2.3 Commercial Marketing of Laser Therapy 2.4 Liability Problems 2.5 Quality Criteria and Quality Assurance 2.6 Note Conclusion Suggested Reading 3: Avoiding Side Effects and Complications in Laser Applications 3.1 Parameters Determining Therapy Skin Type/Tanning Degree Energy Density Wavelength Beam Diameter Pulse Duration Pulse Shape 3.2 Practical Aspects Cooling Implementation Pre-/Posttreatment 3.3 Management of Treatment Errors Patient Selection Information Intervals Test Treatment 3.4 Errors and Complications Conclusion 4: Postgraduate Education to Assure Quality Standards of Photonic Treatment 4.1 Diploma in Aesthetic Laser Medicine (DALM) 4.2 Plasma & Aesthetic Laser Medicine (PALM) Content Target Group Curriculum Examination Degrees Teaching Body Tuition Fees 4.3 Conclusion Suggested Reading 5: Training Concept for Laser, IPL, and Other Optical Radiation Sources 5.1 Training Prerequisites 5.2 Theory (Technical Knowledge) Physics and Equipment Science Physical Basics Laser-Tissue Interactions Cooling Photodocumentation of Treatment Results Hygiene Patient Consultation and Counselling Avoidance of Complications Skin General Biology Efflorescence Theory (Reliable Command of the Description of Findings) Special Features of Systemic Diseases or Special Skin Conditions or Physiological Changes Detection of Inflammatory Skin Changes Systemic Diseases with Skin Involvement Pathogen-Related Skin Diseases Skin Tumors Hypersensitivity Reactions of the Skin and Allergies Autoimmune Diseases for Detection as Exclusion Diagnoses Sebaceous Gland Disease (Including the Basic Forms of Treatment) Vessels, Vascular Diseases, and Diseases with Vascular Involvement Typical Vascular Diseases Hair Follicles and Diseases Physiology of Chromophores Light-Related Diseases/Photodermatoses Virus Infections Skin Tumors in Particular Benign Tumors and Organoid Nevi Precancerous and Malignant Tumors Skin: Acne and Acne Scars Light-Based Therapies That Act on Connective Tissue and Sebaceous Glands Photodynamic Therapy Skin: Scars, Keloids, and Stretch Marks Scar types Pretherapeutic Assessment of the Patient Posttherapeutic Care Skin: Wrinkles (Partly Overlaps with Scar Therapies) Classic Resurfacing and Subsurfacing Fractionated Ablative and Non-ablative Lasers Periorbital Folds Alternatives/Additions to Ablative Laser Treatments Skin: Fatty Tissue (Sweat Glands) Laser-Assisted Liposuction (Laser Adipocytolipolysis) Skin: Chromophore Melanin/Pigments Benign Hyperpigmentations Tattoos and Other Dyschromias Vitiligo and Other Hypopigmentations Laser and Light Depilation for Unwanted Hair Growth Skin: Chromophoric Hemoglobin Endoluminal Laser Therapy for Varicosis Special Application Areas of IPL Technology Photodynamic Therapy (PDT) Experimental Laser Techniques Malpractice Economic Aspects 5.3 Practice (Expertise) Proof of Expertise Expertise Certificate of Competence Requirement of Device-Specific Training (Analogous to Specialist Standard) Further Training Ethics Legal Basis Occupational Health and Safety Device Safety (Maintenance, Requirement for Med. CE Devices) 5.4 Population Register Conclusion Suggested Reading Part II: Legal Basis 6: Personal Qualification of the User 6.1 Reservation of Doctor’s Rights in Accordance with the Requirements of the Heilpraktikergesetz (Law on Alternative Practitioners) Further Qualification Requirements by the NiSG What Does this Mean in Concrete Terms for Laser and IPL Technology? What Are the Decisive Parameters Here? 6.2 Typical Applications of Lasers and IPL Devices Removal of Pigmented Marks Removal of Warts Removal of Dilated Skin Vessels Removal of Tattoos Removal of Hair (Epilation) 6.3 Delegation to Nonmedical Staff 6.4 State of the Case Law 6.5 Conclusion 7: Patient Education and Implementation of Legislation 7.1 Legal Basis in the Patients’ Rights Act 7.2 Treatment Contract and Relationship 7.3 Patient Education Time Implementation and Documentation Dispensability Content and Scope 7.4 Economic Education 7.5 Education of Minors 7.6 Documentation of the Treatment Inspection of the Patient File 7.7 Burden of Proof in Case of Liability Conclusion Suggested Reading 8: Legal Framework 8.1 Law for Protection against Nonionizing Radiation in Human Applications (NiSG) 8.2 Ordinance on the Protection of Employees from the Hazards of Artificial Optical Radiation (Ordinance on Artificial Optical Radiation – OStrV) 8.3 Technical Rules as OStrV Implementation Guidelines for Laser Protection 8.4 Technical Rule for the Ordinance on Industrial Safety and Health in Artificial Optical Radiation – TROS/Incoherent Optical Radiation (IOS) General Information Assessment of Hazards Arising from Incoherent Optical Radiation TROS IOS Part 1 Measurements and Calculations of Exposures to Incoherent Optical Radiation TROS IOS Part 2 Measures to Protect against Hazards Arising from Incoherent Optical Radiation TROS IOS Part 3 Risk Assessment (§ 3 OStrV) 8.5 Act on Medical Devices (Medical Devices Act – MPG) 8.6 Ordinance on the Installation, Operation, and Use of Medical Devices (Medical Devices Operator Ordinance – MPBetreibV) Functional Testing of Medical Devices/Instructions Keeping a Medical Device Book Creating an Inventory List Implementation of Safety and Metrological Controls Immediate Availability of Instructions for Use for the User 8.7 Second Ordinance to Amend Medical Device Regulations 8.8 Ordinance on the Identification, Assessment, and Prevention of Risks Associated with Medical Devices (Medical Device Safety Plan Ordinance – MPSV) Toxic or Infectious Substances Conclusion Suggested Reading 9: Legal Conditions in Switzerland 9.1 Conclusion Part III: Laser, IPL and Other Energy Sources 10: Understanding the Biological Effects of Ablative and Non-Ablative Laser Systems in the Skin as Key to Avoiding Complications 10.1 Biological Effects of Laser Treatment on the Human Skin Ablative CO2 Laser Er:YAG Ablative Laser Non-Ablative Er:Glass Laser Bottom Line Suggested Reading 11: The Flashlamp-Pumped Pulsed Dye Laser: Energy/Effects/Side Effects 11.1 Flashlamp-Pumped Short-Pulsed Dye Laser with 585 Nm (595 Nm)/450 μs (“Flashlamp-Pumped Pulsed Dye Laser,” FPDL) Short Description of the Device Type Application Areas Device Type, Physical Principles, and Mode of Action Treatment and Course of Therapy 11.2 Long- and Superlong-Pulsed Dye Lasers (PDL Lasers) Brief Description of the Device Type Fields of Application Device Type, Physical Principles, and Mode of Action Treatment and Course of Therapy 11.3 Selection of Current Dye Laser Models Cynergy MPX and Dye and Nd:YAG Combination Laser with Multiplex Technology Candela-Vbeam Perfecta Synchro VasQ 11.4 Prerequisites for Practical Use Personal User Requirements 11.5 Contraindications 11.6 Security Measures (General and Specific Optical) Necessary Equipment, Space, Size, Protective Goggles Safety Measures Due to Optical Hazards Due to the Use of Dye Lasers Technical Rules for the Ordinance on Industrial Safety and Health Concerning Artificial Optical Radiation (TROS Laser Radiation) Dangers to Eyesight Injuries to the Eye Technical Rules for the Occupational Health and Safety Ordinance on Artificial Optical Radiation (TROS Laser Radiation) 11.7 Selected Reports, Case Studies, and Studies on the Possible Side Effects of Dye Lasers Preliminary Remark Ulceration and Loss of Breast Implants Scar Sarcoidosis Increase in the Rate of Adverse Reactions with Increased Preoperative Redness and Pigmentation Hyperpigmentation (Fig. 11.3) Recurrence and Darkening of Treated Nevi Flammei Neo-Angiogenesis and Revascularization as Counterproductive PDL Side Effects Topical Tyrosine Kinase Inhibitor Against VEGFR for the Suppression of PDL-Induced Neo-Angiogenesis Bubble Formation in 45.9% Treated Hemangiomas Side Effect Statistics for 500 Vascular Patients Fire Hazard, Risk of Ignition, Origin of Fire Generalized Ulcerative Sarcoidosis Blindness Collected Adverse Drug Reactions Leopard Pattern, Pigment Disorders, and Matting Side Effects in 100 Consecutive Port-Wine Stain Patients Crusts, Pigmentation Disorders, Purpura Scarring, Keloid Formation Scar Ulcer, Ulcerated Keloid After Dye Laser Therapy by a Nonmedical User (Kardorff, Own, Hitherto Unpublished Casuistry) (Fig. 11.2) 11.8 Handling and Dealing with Side Effects Possibilities and Worth Noting for Minimizing Side Effects and Possible Errors and for Avoiding Risks Recommendations for Posttreatment Handling of and Behavior in the Event of Side Effects Bottom Line Suggested Reading Fachliteratur zu Abschnitt 11.1 Zusätzliche Literatur für Nicht-Dermatologen zu Abschnitt 11.1 Fachliteratur zu den Abschnitten 11.2 und 11.3 Einführende und informative Literatur für Nicht-Dermatologen zu den Abschnitten 11.2 und 11.3 Fachliteratur zu den Abschnitten 11.4 bis 11.8 12: Nd:YAG Laser Therapy 12.1 Brief Description of the Method 12.2 Indications 12.3 Physical and Medical Basics 12.4 Practical Implementation Vascular Treatment Pretreatment Treatment Process Parameter Selection Pre-Treatment (Pre-Cooling) Test Treatment Treatment Posttreatment (Post-Cooling) Healing Process and Restrictions After Treatment Continuation of Treatment Epilation Treatment Pretreatment Field Marking Anesthesia Lubricant Treatment Process Parameter Selection Pre-Cooling/Sample Treatment Treatment Posttreatment Cooling Course of Treatment/Restrictions After Treatment Continuation of Treatment Hypertrophic Sebaceous Glands and Xanthelasma/Xanthoma Viral Warts 12.5 Contraindications, Contraindications Vascular Contraindications Contraindications for Photoepilation Fatty Tissue Neoplasms or Deposits 12.6 Side Effects Side Effects of Vascular Treatment Side Effects of Hair Removal Side Effects During Treatment of Fatty Tissues Side Effects During Treatment of Warts 12.7 Information and Consent 12.8 Equipment Treatment Room 12.9 Protective Measures Cooling Safety Goggles 12.10 Evaluation of the Nd:YAG Laser in the Clinical Context 12.11 Instructions for Learning the Method Conclusion Suggested Reading Aktuelle Übersichtsartikel und wissenschaftliche Publikationen Empfohlene Lehrbücher Empfohlene Zeitschriften 13: Quality-Switched Ruby Laser 13.1 Brief Description 13.2 List of Indications 13.3 Physical and Medical Basics 13.4 Treatment and Course of Therapy 13.5 Improving the Effectiveness of Laser Tattoo Treatments by Multiple Treatments or Combinations of Different Laser Systems in a Single Session 13.6 Contraindications 13.7 Side Effects 13.8 Evaluation of the Medical/Diagnostic Results for the Individual Indications 13.9 Notes on Learning the Method 13.10 Note from the Author Conclusion Suggested Reading 14: Erbium:YAG Laser (Er:YAG Laser) 14.1 Brief Description 14.2 List of Indications 14.3 Physical and Medical Basics 14.4 Treatment Planning, Execution, and Course of Treatment 14.5 Ablative Fractional Laser Therapy (AFXL), Laser-Assisted Drug Delivery and Power PDT 14.6 Contraindication 14.7 Side Effect 14.8 Evaluation of the Medical/Diagnostic Results for the Individual Indications 14.9 Notes on Learning the Method Conclusion Suggested Reading 15: CO2 Laser: Its Application Possibilities 15.1 Technical Principles 15.2 Ablative Laser Skin Resurfacing (LSR) 15.3 Use as Surgical Instrument 15.4 Indications/Contraindications Medical Indications Aesthetic Indications Medical and Aesthetic Indications Laser-Assisted Blepharoplasty in Combination with T-LSR and/or F-LSR Contraindications 15.5 Course of Treatment Patient Education and Pre-Treatment Treatment Procedure Treatment Steps Treatment Parameters 15.6 Immediate Postoperative Treatment After T-LSR Covering of the Lasered Skin with Semiocclusive Dressing After F-LSR 15.7 Risks/Sources of Error/Adverse Effects 15.8 Special Features of the Ultra-Pulsed CO2 Laser Device 15.9 Equipment in Practice and Clinic 15.10 Billing Information 15.11 Further Training Conclusion Suggested Reading 16: Intense Pulsed Light (IPL) Technology 16.1 Technology 16.2 Indications 16.3 Fundamentals of Medical Application 16.4 Practical Implementation Pretreatment Treatment Procedure Posttreatment 16.5 Side Effects 16.6 Contraindications 16.7 Necessary Equipment for Operating IPL Systems 16.8 Combination of IPL Devices with Other Laser Systems Using the Example of M22TM Universal IPLTM with Optimal Pulse Technology (OPTTM) (Table 16.1) Multi-SpotTM Nd:YAG (Table 16.2) ResurFXTM (Fractionating, Non-Ablating Laser Handpiece for the Treatment of Striae, Wrinkles, and Scars) 16.9 Evaluation of the Medical-Therapeutic Results for the Individual Indications Conclusion Suggested Reading 17: Energy-Based Devices: Radiofrequency and High-Intensity Focused Ultrasound 17.1 RadioFrequency Bipolar RadioFrequency Multipolar Selective Radiofrequency Fractionated RadioFrequency Indications Body Contouring Skin Rejuvenation Acne Vulgaris Cellulite Acne Scars and Striae Implementation Preoperative Pretreatment Complications Posttreatment 17.2 High-Intensity Focused Ultrasound (HIFU) Indications Implementation Risks 17.3 HIFU and RF Combinations (Table 17.1) Comparison of Thermage, Fraxel Laser, and Fractionated CO2 Laser Conclusion Suggested Reading HIFU 18: Photodynamic Therapy (PDT) 18.1 Basic Principle 18.2 Photosensitizers 18.3 Fluorescence Diagnostics 18.4 Light Sources 18.5 Practical Implementation 18.6 Side Effects 18.7 Indications Actinic Keratoses and Nonmelanoma Skin Cancer (NMSC) Esthetics Acne Vulgaris Sclerosing Skin Diseases Granulomatous Diseases Onychomycosis Bottom Line Suggested Reading 19: Laser-Assisted Photodynamic Therapy 19.1 Introduction 19.2 Epidemiology of Light Skin Cancer 19.3 Supply Options for Light Skin Cancer 19.4 Laser-Assisted Drug Delivery 19.5 Fractional Photothermolysis 19.6 Laser-Assisted Drug Delivery 19.7 The Evolution of PDT Classical Photodynamic Therapy of the Skin Daylight PDT Laser-Assisted PDT Laser-Assisted Daylight PDT Laser-Assisted Artificial Daylight PDT Onychomycosis, Nail Psoriasis, and Nail Dystrophy 19.8 Conclusion References Suggested Reading 20: Phototherapy for Dermatological Diseases 20.1 Introduction 20.2 Visible Light 20.3 Blue Light Blue Light Therapy for Inflammatory Skin Diseases 20.4 Conclusion Suggested Reading Part IV: Special Energy Applications in Medicine and Aesthetics 21: Topical and Systemic Therapy of Rosacea 21.1 Epidemiology 21.2 Pathogenesis 21.3 Clinical Picture 21.4 Topical Therapy Topical Nondrug Therapy General Measures Skin Cleansing and Care Chemical Peeling Topical Drug Therapy Off-Label Therapy Options 21.5 Systemic Therapy Tetracyclines, Doxycyclines Off-Label: Macrolide Antibiotics Metronidazole Retinoids Beta-Blocker, Carvedilol Dapsone Ivermectin Further Active Substances for Systemic Rosacea Therapy 21.6 Special Therapy of Individual Forms of Rosacea Ocular Rosacea Childhood Rosacea 21.7 Conclusion 21.8 Laser and IPL Therapy of Rosacea Light Sources Treatment Before Laser and/or IPL Cooling the Skin During IPL and Laser Treatments Pretreatment Posttreatment with Laser and IPL Results Discussion and Conclusion 21.9 Conclusion Suggested Reading 22: Current Status of Hemangioma and Malformation Therapy 22.1 Hemangiomas 22.2 Vascular Malformations Naevus Flammeus (Port-Wine Stain) 22.3 Conclusion 23: Tattoo Removal 23.1 Laser Systems 23.2 Reconnaissance 23.3 Therapy Performance 23.4 Risks and Dangers Conclusion Suggested Reading 24: Photoepilation 24.1 Fundamentals Biological Basics 24.2 Hair Cycle 24.3 Influence of Individual Factors on Treatment Frequency 24.4 Overview of the Systems Used 24.5 Side Effects 24.6 Indications Mainly Cosmetic Predominantly Medical Iatrogens 24.7 Contraindications 24.8 Preparation of Photoepilation Anamnesis and Clinical Examination Reconnaissance Treatment 24.9 Transsexuality Procedure Accounting 24.10 Conclusion Suggested Reading 25: Laser Treatment of Scars 25.1 Scar Types Immature Scars Mature Scars Linear Hypertrophic Scars Flat Hypertrophic Scars Keloids Atrophic Scars 25.2 Fundamentals of Physiological and Pathological Scar Formation Physiological Scarring Pathological Scarring 25.3 Laser Technologies in Scar Therapy Ablative Lasers Non-ablative Lasers 25.4 Possible Applications Mature Scars Immature Scars Linear Hypertrophic Scars Large Hypertrophic Scars Keloids Atrophic Scars Acne Scars Striae Distensae 25.5 Conclusion Suggested Reading 26: Ultrapulse Fractional CO2 Treatment of Severe Burn Scars 26.1 Introduction 26.2 The Role of Lasers in Scar Management 26.3 An Overview on the Science Behind the Ultrapulse Fractional CO2 Procedure 26.4 The Ultrapulse Fractional CO2 Procedure on Severe Burn Scars Pre-op Evaluation and Setup The Procedure Post-op Management 26.5 Adverse Events 26.6 The Future Suggested Reading 27: Striae Distensae 27.1 Etiology and Pathogenesis 27.2 Evaluation of Striae Distensae 27.3 Management Non-energy-Based Treatments Non-laser, Energy-Based Treatments Full-Beam Laser Treatments Fractional Ablative Laser Treatments Fractional Non-ablative Laser Treatments 27.4 Our Approach to Stretch Marks The Procedure Adverse Events and Their Management Tip and Tricks Dark-Skinned Patients 27.5 Conclusion Suggested Reading 28: Non-ablative Erbium: YAG “SMOOTH” Mode Laser for Intravaginal Application 28.1 Medical and Physical Basics 28.2 Genitourethral Dysfunctions 28.3 Indications Relative Indications 28.4 Practical Implementation Preparation Equipment Necessary Instruments Optional Optical Security Measures General Safety Precautions Execution of Treatment and Course of Therapy Recommendations for Post-treatment Contraindications Reduced Effect Special Indication Test Possible Side Effects Selection of Current Intravaginal Erbium:YAG Therapy Procedures and Devices Evaluation of the Method for Each Indication Requirements for the Practical Use of Non-ablative Er:YAG Therapy 28.5 Notes on Learning the Method Conclusion 29: Hair Transplantation with the Hair Robot 29.1 Short Description of Hair Transplantation Definition Autologous Redistribution Hair Wreath: Donor Area Rare Donor Areas Recipient Area Rare Recipient Areas Operative Alternatives to Hair Transplantation Medical Basics Follicular Unit (Fig. 29.2) Evaluation of the Head Hairs on the Patient Position of the Operation Indication Donor Potential and Donor Area (Fig. 29.3) Hair Shave Receiver Tubules Local Anesthesia and Tumescence 29.2 Division of Hair Root Transplantation into the Following Processes Removal of the Hair Root Groups Supplement to (A) Strip Removal, Preparation, and Separation at the Microscope For (B) Direct Punctiform Single Sampling and FUE Technique Preparation, Intermediate Storage, Check, and Analysis of the Follicular Units Preparation of the Recipient Area Insertion of Hair Root Transplants (Fig. 29.5) Time Window 29.3 Indications 29.4 Physical and Medical Basics 29.5 Practical Implementation of Hair Transplantation Preparation of the Patient Preparation of the Robot Positioning of the Patient on the Robot Actual Drilling or Punching Process Removal of Follicular Units Check and Sorting of Follicular Units Preparation of the Recipient Area Transplantation of Follicular Units Final Discussion and Temporary Dressing 29.6 Contraindications and Contraindications Too Great a Mismatch Between Donor and Recipient Area 29.7 Side Effects and Their Treatment and Enlightenment Notes General Special Side Effects and Side Effects Reconnaissance Instructions 29.8 Necessary Equipment 29.9 Protective Measures 29.10 Complications Early Complications Late Complications Therapy for Skin Necrosis 29.11 Notes on Learning the Method Conclusion Suggested Reading 30: Body Contouring with Cryolipolysis and Shock Wave 30.1 Operating Principle Shock Wave 30.2 Principle of Action of Cryolipolysis 30.3 Treatment Procedure 30.4 Treatment Documentation 30.5 Side Effects 30.6 Contraindications Conclusion Suggested Reading 31: Therapy of Hyperhidrosis with Laser and Other Energy Systems 31.1 Definition of Hyperhidrosis Primary and Secondary Hyperhidrosis 31.2 Pathophysiology of Hyperhidrosis 31.3 Older Treatment Strategies of Hyperhidrosis 31.4 Lasers and Other Energy Systems for the Treatment of Hyperhidrosis Tap Water Iontophoresis (LWI) Laser Externally Applicable Laser Systems Fiber-Based Laser Systems Radiofrequency Thermo Therapy (RFTT) Microwave Thermotherapy (MTT) 31.5 Conclusion Suggested Reading 32: Aesthetic Plasma Medicine 32.1 Introduction 32.2 Plasma Effect Plasma Jet 32.3 Aesthetic Indications Infected and Poorly Healing Wounds Wound Areas at Risk of Infection Aging Skin 32.4 Practice Conclusion Suggested Reading Part V: Side Effects of Skin Treatments 33: Side Effects: A Worldwide Literature Search 33.1 Organs Concerned: Skin and Eye Eye Skin Skin: Co-treatment of Melanocytic Nevi 33.2 Type of Side Effects (Parameter Selection, User Error, Device Error) 33.3 Literature on Side Effects: Difficulties in Assessing the Data Collected 33.4 Literature Complications/ Eyes 33.5 Literature Complications/ Skin Conclusion Suggested Reading Part VI: Management of Energy Therapy on the Skin 34: Photo Documentation and Digital Skin Analysis for Medical/Aesthetic Procedures 34.1 Documentation of Findings 34.2 Photo Documentation Short Description of the Method Indications Basic Principles Practical Implementation Preparation Photography Therapy Recommendation Treatment Simulation Photo Documentation Necessary Equipment and Equipment Costs Staff Expenditure of Time Premises Material Requirements 34.3 Special Features of Individual Devices FotoFinder Adonia® 34.4 Evaluation of the Medical and Diagnostic Results for the Individual Indications 34.5 Accounting Information Conclusion Suggested Reading 35: Cooling Techniques 35.1 Cooling Method Overview Contact Cooling Contactless Cooling Liquid Nitrogen Halogenated Hydrocarbons Cold Air Problems, Developments, and Prospects Bottom Line Suggested Reading 36: Light Protection: Before and After IPL, Laser, and PDT Treatments 36.1 Principles of Photoprotection Recommendations on Exposure Behavior Textile Light Protection Dermocosmetic Light Protection Determination of the Light Protection Factor Filter Substances 36.2 UV Protection and Photocarcinogenesis 36.3 UV Light Protection and Photoaging 36.4 UV Light Protection and Photodermatosis 36.5 Phototoxic and Allergic Reactions 36.6 Postinflammatory Hyperpigmentation 36.7 Post-interventional External Therapy Conclusion Suggested Reading 37: Safety Check and Maintenance: Or why Maintenance of a Laser Device Makes Good Sense 37.1 Measurement of Laser Energy 37.2 Cooling 37.3 Effects of Missing Maintenance Work 37.4 Maintenance Work by the User Conclusion Suggested Reading 38: Side Effects and Complications of Lasers and IPL 38.1 Introduction 38.2 Complications Caused by Laser Radiation and Smoke Particles Eye Injury Smoke Particle Inhalation 38.3 Side Effects and Complications of Laser Treatment Reddening Swelling and Edema Purpura Pigment Disorders Bubble and Crust Formation Scars Infections Color Change and Allergic Reaction to Tattoos Development of Pseudomelanomas Paradoxical Effects After Hair Treatment 38.4 Summary Suggested Reading Appendix A A.1. on Chapter 5 Index