Low level laser/light therapy for skin rejuvenation

For decades, cosmetic rejuvenation procedures have clustered around the two main approaches. Approach One: cut, remove, mechanically readjust or implant something (examples include facelift, tummy tuck, liposuction, injectable fillers, chin implants and many others). Approach Two: damage the skin in a controlled and limited way and wait -- the skin would then remodel itself as it heals, leading to a firmer, smoother texture (examples include laser or plasma skin resurfacing, radio frequency treatment, fractional resurfacing, ultrasound, chemical peels and others). Unfortunately, both approaches have significant limitations. The first tends to be very expensive (as is typical for invasive procedures), often requires prolonged recovery, may produce major side effects and does not improve skin texture. The second one is also rather expensive, often requires some recovery time and not infrequently causes side effects, including significant ones, occasionally leaving the skin worse off then before.

Understandably, people have been searching for effective alternatives with favorable side effect profile yet without high costs and downtime. Finding such alternatives has not been easy. Topical agents may help to stave off the signs of aging and provide modest improvements but their effects tend to be neither quick nor dramatic. Skin needling appears promising and has a comparatively good side effect profile. However, some people find it unpleasant and also its popular DIY version may be less effective then the more aggressive and expensive professionally performed alternative.

Luckily, there seems to be another procedure that promises a unique balance of good effectiveness, minimal side effects, no downtime, reasonable cost and a DIY option. It is called low level laser/light therapy or LLLT. Low level laser/light therapy is based on the ability of certain frequencies of visible and near infrared light to stimulate repair, renewal and remodeling of tissues, including the skin, as well as reduce inflammation and protect from certain types of tissue damage.

The main and best documented applications of LLLT in medicine are for tissue and nerve regeneration, wound healing as well as reducing pain and inflammation. More recently, LLLT has been used for skin rejuvenation. It was reported to improve wrinkles and skin texture, reduce skin laxity and diminish scars. Preliminary data indicate that it might also improve a number of skin conditions, including acne, certain pigmentation disorders, burns and possibly psoriasis. The research into LLLT for skin rejuvenation and treatment is still relatively immature. While some studies showed dramatic improvements, others showed only modest or moderate effects, and some reported no benefit. These variations may be due to the differences in the study design, patient selection and other factors. In particular, there is still some debate regarding optimal light frequencies/intensity for LLLT as well as session frequency and duration. The studies with negative results may have used suboptimal treatment protocols. In any case, given the fair number of positive studies on LLLT in skin rejuvenation (as well as its established track record in tissue regeneration/protection in general) it is worth a serious consideration.

LLLT uses low intensity visible or near infrared light produced either by a laser or a light emitting diode (LED). The wavelengths typically used for LLLT are in the range of 625-700 nm (visible red light) or 700-2000 nm (near infrared light) or a combination of both. The most commonly used are 633 nm red light (produced, for example, by Helium-Neon laser/LED) and 830 nm near infra-red light produced by a number of infrared lasers/diodes.

One should note that LLLT is performed using either laser light or regular light. Laser light is different from regular light in that it is coherent (i. e. its constituent electromagnetic waves are synchronized) whereas regular light is not. Coherent light in LLLT devices is produced either by classical lasers or by laser diodes (a special type of light-emitting diodes or LED) whereas incoherent light is produced by regular LED. The early studies demonstrating LLLT benefits used coherent light. There is some preliminary evidence that as long as the frequency is the same, incoherent light may be as effective as coherent light for LLLT. This question remains open and more research is needed.

So, how exactly does LLLT help in tissue regeneration and skin rejuvenation in particular? All biological processes are based, either largely or entirely, on chemical reactions and interactions, most of which are facilitated by a variety of specialized proteins, including enzymes (biochemicals catalysts), transcription factors (helpers in the synthesis of RNA), and others. Many proteins, which are large and complex polymeric biomolecules, can absorb certain frequencies of red and infra red light and change their activity as a result. One notable example of light-sensitive proteins is mitochondrial enzyme cytochrome C oxidase, which is a key player in cellular energy production. Light can also directly affect some biochemical reactions leading, among other things, to the increased production of certain free radicals, which in turn trigger other reactions. The net result of these effects is a potentially significant change in a variety of key cellular processes. In particular, LLLT was shown to boost the energy production by mitochondria, increase collagen synthesis, stimulate micro-circulation and so forth.

Some researchers argue that in essence LLLT works similarly to the cosmetic skin rejuvenation methods employing controlled damage followed by tissue healing and remodeling. The effects of the light used in LLLT overlap with biochemical changes seen during tissue damage, such as production of free radicals, increase in the inflammatory cytokines (proteins that promote inflammation), activation of matrix metalloproteinases (MMP), etc. Yet the actual tissue damage from LLLT is minimal – typically LLLT produces either no visible side effects or transient erythema (temporary reddening of the skin). However, it might be that LLLT tricks the body into "thinking" that the tissue damage is greater than it actually is – thus triggering a robust and relatively prolonged regenerative response. The first phase of this response includes breakdown of damaged/malformed components of the skin matrix, such as collagen, elastin, and glucosaminoglycans. (Notably, damaged/malformed skin matrix is concentrated in wrinkles, scars and texture irregularities.) This is followed by the synthesis of new skin martix components (in particular, new collagen and elastin) as well as proliferation of fibroblasts, the structurally fundamental type of skin cells. Also, once the rebuilding phase of skin remodeling gets under way, the levels of free radicals, MMP and inflammation are reduced, often below the original baseline. The end result is both structurally and physiologically improved skin tissue better able to withstand future stresses.

The research studies of the benefits of LLLT for tissue healing and regeneration are too many to discuss individually. For those interested in further details, especially in regard to skin rejuvenation, I suggest reading the scientific review of LLLT that also includes numerous references to individual studies.

In summary, based on the studies I've read, LLLT appears very likely to have beneficial effects on tissue regeneration, inflammation and pain control in some areas of clinical medicine. Applied to skin rejuvenation and dermatology, LLLT has shown promise and seems fairly likely to have at least some benefits. However, optimal practices for LLLT use in dermatology remain unclear and require further research. As a result, some of the current dermatological LLLT protocols are likely to be more effective than others and some might even be entirely ineffective. More research is needed to determine whether it is best to use red light, near-infrared light, a combination of both, or even a combination of light therapy and local heating. Also, researchers need to find out the optimal frequencies, intensities, duration and periodicity of treatments as well as whether coherent light sources (lasers) have any advantage over the non-coherent ones. I am hoping that non-coherent light sources (such as ordinary LED) prove effective because using cheap LED arrays simplifies treatment of large ares of the skin, which is especially useful in skin rejuvenation and dermatology.

Even though research into the LLLT use in dermatology remains incomplete, there is a variety of LLLT devices on the market, both for professional and home use. As I mentioned, since dermatological LLLT research is immature, there isn't enough data to determine which devices are best and how to best use them.

Does this mean that one should wait until definitive research on optimal dermatological LLLT practices is available? This is probably a matter of personal philosophy about decision making in uncertain conditions. It is certainly more prudent to wait until more comprehensive knowledge is available. On the other hand, a variety of skin rejuvenation and plastic surgery methods became widely used before all their aspects were fully researched (e. g. radio frequency therapy, ultrasound, plasma resurfacing and others). LLLT is milder and appears to have much better side effect profile than most other rejuvenation procedures. Hence, even if LLLT is used incorrectly, it would still probably just harm your wallet and not your skin. And considering that further research may take years or decades, not waiting for it before giving LLLT a try may not be unreasonable – as long as one understands the remaining uncertainties and risks.

Please keep in mind that it is prudent to try any new treatment on a test area outside the face and neck first, to make sure there are no unexpected adverse reactions or side effects.