IPL, or intense pulsed light, was introduced to the aesthetic market in the mid 1990’s. IPL is also sometimes referred to as a ‘photofacial’. Though an IPL may look, sound and feel like a laser, it is not classified as a true “laser”. IPL is not a true laser because it uses multiple wavelengths of light, whereas lasers use only one wavelength of light. Just because it is not a true laser, does not mean that IPL is any less effective or less complicated of a treatment. Multiple wavelengths of light can actually be an advantage when used by an experienced operator. Some wavelengths of light are more effective for treating pigmentation, while other wavelengths are better for treating blood vessels or redness. Using an IPL with various wavelengths can allow for treatment of multiple conditions in one session. Even though an IPL is not a laser, it is still important to know who is performing your procedure.
IPL devices have evolved significantly since their introduction. Many now have numerous settings, including the ability to adjust the range of wavelengths, how long the delivery of light is (pulse width), and even the cooling temperature. While these additional features are of great use for the experienced operator, it sometimes makes these devices difficult to use for a novice user. Many IPLs come with a cooling plate that is applied to the skin, while some use an air cooler. The cooling is used to protect the outermost layer of the skin (epidermis) from burning and to make the treatment more comfortable. If the cooling is not functioning properly, burns can result. If the cooling is too high, then the treatment may not be as effective for pigmentation. The same is true with wavelength determination with IPLs. Most have filters which block some wavelengths and emit others. Changing the wavelengths that are emitted from the device allow for the treatment to be tailored for a patients skin type and condition being treated.
IPL devices can be used to treat various skin abnormalities. Different IPLs have different handpieces, allowing some systems to be very versatile. The primary treatment for the IPL is pigmentation. These can include sun freckles (lentigenes), melasma (patches of dark pigment), freckles (ephiledes), or actinic bronzing (sun damage/photoaging). Broken blood vessels (telangiectasias) can also be treated with an IPL system. Other conditions treated with IPL include: poikiloderma of Civatte, port wine stains, rosacea, acne, and wrinkles. In addition, skin elasticity has been shown to improve following 3 sessions with IPL. Other IPLs may function for hair removal, or serve as the power source for a laser handpiece. Regardless of their intended use, IPL is very adaptable and effective when used properly by an experienced user.
The light enters the skin and is absorbed by targets. These targets can include pigmentation, or abnormal vessels. Some of the light will be absorbed by the target and then transferred to surrounding tissues as heat. This heat is what selectively destroys abnormal pigment or vessels. In addition, the heat stimulates collagen production. Several studies have shown that IPL improves collagen after even one session. Pigmentation which has absorbed the IPL light effectively will darken and form a thin crust a few days after the treatment. The darkening looks almost like a sun spot that was colored with a dark pencil. It is not a thick crust or scab. Vascular lesions that are treated will look slightly redder for a few days and then lighten. It is important to use good sun protection both before and after a session of IPL.
Frequently anywhere from 1-5 sessions are required for IPL treatments. As all IPL devices are slightly different, the following description is of a typical session. Numbing is generally not needed for this procedure, except in some cases of hair removal. The skin should be completely clean and free of makeup or sunscreens. Many devices require a thin layer of cool ultrasound gel to be placed onto the skin surface. The IPL handpiece is then placed directly against the skin. Each pulse of the IPL may feel like a light snapping. It should be a tolerable procedure. If the treatment is very painful, then the session should be stopped. It is better to be cautious and repeat the procedure after test spots are performed if there is any doubt about how the skin is responding. An experienced operator will know what the normal skin response should be.
IPL treatments are used on many skin types, yet the risk of complication is higher the darker the skin type. Patients with very dark skin (Fitzpatrick type VI) should not be treated with a traditional IPL device. Darker skin types (Fitzpatrick type V) should be treated with caution using a device that has adjustable cooling and wavelength and only in experienced hands. The same is true for tanned skin. For those with very light skin, IPL treatments are less risky and complications more rare.
Complications can arise from improper use, incorrect settings, or inaccurate technique. These include crusting, discoloration of the skin (dark or light), blistering, or even scarring. Certain skin types are more prone to complications with an IPL. Dark or tan skin should be treated with extreme caution, if at all. Also, certain areas of the body are more prone to complications, including the chest and neck. Settings need to be altered in these areas, and it takes an experienced operator to understand these variables.
Objective and non-invasive evaluation of photorejuvenation effect with intense pulsed light treatment in Asian skin.Shin JW, Lee DH, Choi SY, Na JI, Park KC, Youn SW, Huh CH.J Eur Acad Dermatol Venereol. 2010 Jul 29. [Epub ahead of print
Intense pulsed light (IPL): a review.Babilas P, Schreml S, Szeimies RM, Landthaler M.Lasers Surg Med. 2010 Feb;42(2):93-104. Review