Advances in light-based therapy

Miss Jennifer Doyle and Mr Richard Scawn consider how advances in light-based therapy can be used for anti-ageing and skin rejuvenation

Pulsed light treatments are widely adopted for treating common skin concerns associated with sun exposure and ageing. Broadband light (BBL) is a newer option in the United Kingdom which offers added functionality on intense pulsed light (IPL) technology in the form of versatility, efficacy, and speed over a wide variety of treatment indications.1

BBL is an advanced pulsed light device¹ that emits light in both the visible and infrared spectrum.2 Based on the theory of selective photothermolysis, the light heats selected target chromophores within the tissue to a therapeutic endpoint, without affecting surrounding tissue.³ It is important to note that BBL is not a laser, and the output of light ranges from 400nm to 1400nm. Melanin, haemoglobin, and water are the targets across this range of wavelengths. Unlike a laser, BBL emits multiple wavelengths within a band of light, allowing multiple targets to be treated at the same time. The light is generated from dual xenon flashlamps within the handpiece and delivered to the tissue via an electronically cooled sapphire crystal. BBL uses wavelengths at 515nm, 560nm, 590nm, 640nm, and 695nm to adjust the band of light for specific treatment indications and the patients’ Fitzpatrick skin type.3 By using longer wavelengths emitting less visible light, BBL can be safely used in darker skin tones, up to Fitzpatrick V. The system also includes a 420nm blue light filter that is part of a protocol for the treatment of active acne. In addition to the 15x45mm crystal, the user can also adjust the treatment area with the use of ‘finesse adaptors’. The adaptors include a 15x15mm, 11mm, and 7mm spot size for treating smaller areas such as the lips or forehead. They are perfect for spot treatment for individual lesions or vessels to ensure clearance. New users can utilise user-friendly application-driven software to calculate appropriate settings for skin type and indication. The individual settings can always be customised for advancing protocols and creating a bespoke treatment plan for each patient.

Launched in America in 2004, BBL has greatly evolved to become a market-leading pulsed light treatment.¹ It is commonly used for skin rejuvenation by clearing pigmented lesions, diffuse redness, thread veins, and active acne. The system is also highly capable of permanent hair reduction in skin types I-V by utilising either a stamping or ‘in-motion’ technique.4 Corrective skin rejuvenation treatments are offered in a series of three treatments spaced two to four weeks apart. The treatment is often safely combined with other skin rejuvenation treatments, such as microneedling, radiofrequency microneedling, Hydrafacials and fractional laser in a single session as a stacked treatment.

Before and after photos of a single treatment with BBL and fractional non-ablative laser 1927nm

Forever Young BBL is an anti-ageing protocol you can perform with the system. The idea of this treatment is to maintain overall skin health and preserve the results of corrective aesthetic treatments. Increased dermal collagen has been shown in biopsies after BBL therapy. Improvements in skin blemishes such as lentigines, telangiectasias, pore size and skin texture have also been proven. Further study of the long-term anti-ageing effects of BBL took place at Stanford University in California.5 The study examined the effect BBL had on gene expression patterns in a group of patients. Of 2,265 coding and non-coding RNAs associated with skin ageing, 1,293 became ‘rejuvenated’ after BBL treatment. In other words, they were expressing much more similarly to levels seen in youthful skin. The study further concluded that known key regulators of organismal longevity were restored and that BBL therapy can reverse the gene expression pattern of photoaged and intrinsically-aged human skin to resemble younger skin. These findings, along with the associated treatment protocol that was developed, offer significant benefits to patients seeking a proven way to maintain youthful skin.⁶ The Forever Young BBL treatment can also be enhanced as a combination therapy with different peels and lasers that stimulate epidermal turnover.

The BBL system includes a treatment protocol for the correction of skin laxity through bulk heating of the dermis.7 Achieving improvement of skin laxity through heat-induced collagen shrinkage is well documented.7 Successful treatment depends on a combination of time and temperature to achieve collagen denaturation. After a series of up to five treatments, this denaturation results in new collagen deposition and shrinkage. The skin tightening protocol delivers the light over continuous pulses that can be used throughout the entire body and on all skin types. Darker skin tones are safely treated by using wavelengths with reduced visible light such as 695nm and 800nm. All areas are treatable and popular treatments include the crow’s feet, lower face, neck, chest, hands, abdomen, and above the knees. You must choose the right candidates and set proper expectations to ensure the best results. Ideal candidates have an appropriate amount of laxity (too much could require surgical intervention) and understand the full series must be completed. Younger patients should understand that this is a maintenance treatment if there is little laxity. For this group, the benefit will be increased collagen and a preventative effect on visible ageing.

Large areas, such as arms, backs and legs with long treatment time, can prove a challenge for pulsed light devices. These treatments can take up valuable time on the schedule and are often overlooked by providers offering phototherapy. Another challenge is striping, which is commonly seen in larger areas where it is more difficult to perfectly line up the individual pulses. Enter BBL Hero, which is a new “in-motion” delivery method for skin rejuvenation. When utilising the Hero treatment mode, BBL technology allows for treatment speeds of up to four pulses per second (4 Hz).³ This high-speed ‘in-motion’ skin rejuvenation technique has dramatically reduced treatment times in large areas. The risk of patient striping is also reduced with the ability to quickly deliver multiple passes on any given area. All of this also translates into more efficacious and repeatable results by having the capability of delivering a higher number of pulses to the treatment area. Higher pulse counts result in more patient response.⁸ By using a higher pulse count as an endpoint, practitioners can easily duplicate treatments across similar patients and thus replicate results. Based on feedback from my patients, this treatment modality is more comfortable than traditional static IPL and opens the door to treating larger areas of the body which greatly increases the return on investment of the device.

The protocol is a versatile tool for any practice which offers a wide variety of treatments in a single technology. The treatment offers true differentiation in a space with lots of choices.

MISS JENNIFER DOYLE

Miss Jennifer Doyle is a consultant oculoplastic surgeon based at The Clinic at Holland Park and at Milton Keynes University Hospital. She has a Bachelor’s in Medicine and a Bachelor of Surgery with distinction, as well as a Master’s in Medical Sciences from the University of Oxford. Qual: BMBCh, MA(OXON), L7Cert, FRCOphth

MR RICHARD SCAWN

Mr Richard Scawn is a consultant ophthalmologist and oculoplastic surgeon based at The Clinic at Holland Park, Harley Street and leads the oculoplastic service at Chelsea & Westminster NHS Trust. He is a surgical wet lab instructor in London, Dubai, and the US. Qual: MBBS, BSc, FRCOphth