XEO+ laser: pigment, vessels and unwanted hair

A laser delivers light at a wavelength absorbed preferentially by a particular structure. The absorbed energy becomes heat, and the heat damages that structure while the surrounding tissue, which absorbs less, is comparatively spared.

For sun spots, the target is melanin in the pigmented lesion. The spot typically darkens after treatment, then flakes away over the following one to two weeks.

For facial and leg veins, the target is haemoglobin in the vessel. The vessel wall is damaged, the vessel collapses, and the body clears it over subsequent weeks.

For unwanted hair, the target is pigment in the follicle, which is only vulnerable during the active growth phase. Since follicles cycle independently, only a proportion are treatable at any one appointment, which is the entire reason hair reduction requires a series rather than a session.

A pigmented lesion must be examined before it is treated with light. Some pigmented lesions need dermatological assessment rather than cosmetic treatment, and lasering something that should have been biopsied removes the evidence without removing the problem.

This is not a formality. Florida has among the highest rates of skin cancer in the country, and any clinic treating pigment here should be examining what it is treating and referring where there is any doubt. If a mark has changed in size, shape or colour, or is new and behaving differently from your others, say so.

Melasma is the other case that needs naming, because it is a pigment problem that heat can worsen. Treating melasma as though it were sun damage tends to make it worse rather than better, so it gets its own plan.

Laser treatment of pigment on recently tanned skin carries a higher risk of unwanted pigment change, because the laser cannot distinguish the pigment you want treated from the tan you have acquired. That is why we ask about recent sun exposure and upcoming holidays, and why we sometimes postpone.

The practical answer on this coast is to schedule these courses for your lowest-exposure stretch, and to be realistic about what that means if you are on the water most weekends.

Afterwards, daily broad-spectrum sunscreen protects the result. Pigment treated successfully will return with continued unprotected exposure, because the cause has not changed.