Dr. Dieter Manstein
President, American Society for Laser Medicine and Surgery
The field of laser skin therapy has been evolving over the past few decades. One of the key innovators in the field, Dr. Dieter Manstein, explains the benefits of laser treatments.
Manstein, the president of the American Society for Laser Medicine and Surgery, is responsible for some of the greatest innovations in laser skin treatment, from cosmetic improvements to wound and scar healing. He co-invented fractional photothermolysis, which made laser therapy a leading treatment for aging or scarred skin.
In developing fractional photothermolysis — where a laser’s beam is broken into tiny fractional points, which minimizes the risk of burning — Manstein originally sought a way to improve the appearance of aging or sun-damaged skin. But many other applications emerged.
“It turned out the treatment of scars was also very effective and specifically the treatment of burn scars,” he said. “You’re not just treating the appearance of the skin, you basically reorganize the collagen fibers, because a small wound heals better than a large-sized wound. It really has changed the paradigm for how burn scars are being treated.”
Coming a long way
In the early days of laser skin therapy, the results were less than perfect.
“In the ’90s, laser resurfacing was very popular,” Manstein said. “What that means is you take a laser beam — typically a CO2 laser was used — to generate a very thin layer of surface burn. You could call it a laser peel.”
While the results of this laser treatment made good aesthetic improvements, the treatments required lengthy recovery time and had dangerous side effects.
“It was very popular, but essentially it’s a superficial burn,” Manstein said. “There were a couple of cases where it was overdone and there was too much thermal wounding.”
As a result, a new technique emerged in the early 2000s known as sub surfacing.
“It tried to be completely noninvasive,” Manstein said, “to do a little bit of diffuse thermal injury and some collagen stimulation without actually damaging the epidermis at all.”
While offering a much safer option, sub surfacing didn’t make for visible results.
“It didn’t go too well because the results were very minor,” Manstein said. “People weren’t very happy with that.”
A new approach
Around this time, Manstein was working at the Massachusetts General Hospital at Harvard Medical School. He was developing a technique of using microscopic laser points to disperse the thermal wounding.
“We came out with a new approach called fractional resurfacing,” he said, otherwise known as fractional photothermolysis.
Previous laser resurfacing techniques of the skin could deliver too much heat over the treatment area, potentially causing thermal skin damage.
“This would be the equivalent of putting a hot cigarette on the skin,” Manstein said.
By breaking up the laser effects into tiny fractional points, approximately a hair’s width, the skin heals faster and the risk of causing burn injury is greatly minimized. The benefits for patients with scars go beyond the aesthetic.
“It’s not just that the skin looks better,” Manstein said, “there’s more range of motion, it’s not so contracted anymore.”
As far as lessening the effects of aging, Manstein said the trend now is to get ahead of the curve.
“These days, due to the new treatment opportunities, some patients are much more proactive and delay the aging process with laser treatment,” he said. He also recommended preventative measures, such as reduced sun exposure and a healthy lifestyle.
Now Dr. Manstein is helping educate physicians about the benefits of this laser therapy.
“Even in the physician community, surgeons are not so aware of this yet, because it is still relatively new,” he said.
Manstein hopes patients start to feel empowered to seek the best treatment options available.
“I strongly feel that burn scar patients should at least know about this option,” he said, “and specifically inquire their physicians about it.”
Ross Elliott, [email protected]