In the world of Medical Aesthetics, many treatments and procedures use devices with lights and lasers. As an industry that truly merges science and aesthetics, these innovative, technology-focused devices are often attractive to patients and clients because they can be less invasive than full surgical procedures. Let’s take a look at one that, after 25 years, continues to grow in popularity due to ongoing innovations in technology, treatment protocols, and technique: IPL.¹

A working definition for IPL.

IPL stands for intense pulsed light. It’s a type of light therapy used to treat wrinkles, spots, and unwanted hair.

IPL is used to minimize or remove:

• Age spots
• Sun damage
• Freckles
• Birthmarks
• Varicose veins
• Broken blood vessels on your face
• Rosacea
• Hair on your face, neck, back, chest, legs, underarms, or bikini line

IPL can be used anywhere on the body, but it may not work as well on uneven areas. It isn’t recommended for people who tend to get thick, raised keloid scars or who have darker skin tones. It’s also not as effective on light-colored hair as it is on darker hair.²

How IPL works.

IPL devices are non-laser high-intensity light sources that make use of a high-output flashlamp to produce a broad wavelength output of noncoherent light, usually in the 500 to 1200 nanometer (nm) range. Light pulses generated by most modern devices are produced by bursts of electrical current passing through a xenon gas-filled chamber. The lamp output is then directed toward the distal end of the handpiece, which, in turn, releases the energy pulse onto the surface of the skin via a sapphire or quartz block. Individual systems use different cooling systems, such as a cryogen spray, contact cooling, or forced refrigerated air, to protect the epidermis in contact with the conduction crystal of the handpiece.

Individual light pulses have a specific duration, intensity, and spectral distribution allowing for a controlled and confined energy delivery into tissue. IPL use in dermatology relies on the basis that certain targets for energy absorption (chromophores) are capable of absorbing energy from this broad spectrum of light wavelength (absorptive band) without exclusively being targeted by their highest absorption peak. The working basis of the IPL rests on the principle of selective photothermolysis, in which thermally mediated radiation damage is confined to chosen epidermal and/or dermal pigmented targets at the cellular or tissue structural levels. Tissues surrounding these targeted structures, including overlying or immediately neighboring cells, are spared, potentially reducing nonspecific, widespread thermal injury. The three main chromophores (hemoglobin, water, and melanin) in human skin all have broad absorption peaks of light energy, allowing them to be targeted by a range as well as a specific wavelength of light. Therefore, monochromaticity of the light beam is not a prerequisite for selective heating of target structures in human skin. The broad wavelength range discharged from an IPL device leads to the simultaneous emission of green, yellow, red, and infrared wavelengths allowing the various chromophores to be targeted concurrently.³

The difference between IPL and laser treatment.

IPL is similar to laser treatment. However, a laser focuses just one wavelength of light on the skin, while IPL releases light of many different wavelengths, like a photo flash.²

The light from IPL is more scattered and less focused than a laser. IPL penetrates down to the second layer of the skin (dermis) without harming the top layer (epidermis), so it causes less damage to the skin.²

Pigment cells in your skin absorb the light energy, which is converted into heat. The heat destroys the unwanted pigment to clear up freckles and other spots. Or, it destroys the hair follicle to prevent the hair from growing again.²

Another well-recognized advantage of IPL devices is the relatively large footprint of their spot size and their resulting treatment speed, allowing one to limit the total number of pulses per treatment to a minimum and affording a swift treatment of large anatomical areas. Nonetheless, the larger handpieces and spot sizes can pose a potential maneuverability disadvantage when treating uneven skin surfaces.³

Discussing IPL with your patients.

Pretreatment patient counseling and managing individual patients’ expectations is an integral part of successful light-assisted or laser hair removal. Patients should be guided to understand that multiple treatment sessions will likely be necessary and that their hair will gradually become finer and sparser.³

Treatment with the IPL device is generally well tolerated by most people when using standard energy settings. Priming the skin with topical anesthetic creams for an hour before treatment will further help alleviate some discomfort, but is not always necessary. Although rarely observed in the hands of an experienced user, potential complications from IPL hair removal with excessive energy or improper technique include hyperpigmentation, hypopigmentation, folliculitis, and paradoxical hypertrichosis.³

Understanding risks and potential side effects of IPL.

IPL is safe for most people but is not suitable for everyone. Pregnant women and people who are on blood thinners, for example, should avoid IPL.⁴

Other factors that make people unsuitable for IPL treatment include:

• Currently or recently taking the acne drug Accutane
• Having active acne
• Suffering from a skin resurfacing disorder
• Being susceptible to keloid scarring
• Having severe scarring
• Having suffered severe sunburn recently⁴

As with any medical procedure, IPL does carry the risk of complications. These include:

• Pain
• Skin discoloration
• Swelling
• Infection
• Bleeding
• Scarring
• Crusting⁴

Who can perform IPL treatments?

IPL treatments should only be administered by a professional who is properly trained, licensed, and/or certified. Regulations vary from state to state, so check your state’s requirements. Many states classify laser treatments as medical treatments, and their use is therefore limited to medical professionals, such as dermatologists. However, this is not always the case. In some states, there are no laws specifying the use of lasers. This makes the use of IPL devices by aestheticians a gray area in many states, which makes seeking professional, credible training especially important to help keep patients and clients safe.⁵

For example, in California, aestheticians are strictly prohibited from using IPL devices, while in Washington State, only master aestheticians are permitted to operate IPL devices.⁵ It’s also worth noting that legislation changes and adapts over time, so regularly check what your state’s requirements and regulations are when it comes to lasers and light devices.

Newer uses for IPL.

Although IPL has primarily been used for hair removal and hyperpigmentation treatment, it has also shown some effectiveness in treating fine lines and wrinkles. A series of 4 to 6 IPL treatments termed “photorejuvenation” has recently been popularized and is available in many dermatology practices nationwide. The principle behind tightening of the skin using IPL rests on the theory that heating collagen fibers with high-intensity light energy lead to their contracture. This may account for the textural change described in skin treated with IPL, which has been reported as a secondary observation in several studies. Furthermore, the thermal stimulation of dermal fibroblasts by the higher wavelengths within the IPL spectrum has been shown to result in increased synthesis of extracellular matrix proteins, leading to at least partial replacement of the lost dermal volume. Specifically, wavelengths in the 1200nm spectrum are absorbed by water in the dermis, triggering a cytokine reaction, which, in turn, stimulates the formation of new collagen I, III, and elastin. Histological evaluation of the effects of five subsequent IPL treatments with 570 to 645nm wavelengths showed epidermal thickening of 100 to 300 micrometres (μm), a decrease in horny plugs, new rete ridge formation, a decrease in the proportion of degenerated elastic fibers, and new dermal collagen formation.³

The most commonly targeted wrinkles are those in the perioral and periorbital regions, with finer, more superficial lines typically responding better than deeper furrows. Results are often subtle and require multiple treatment sessions. Recent studies suggest that combining localized or full-face IPL treatments with concomitant botulinum toxin injections for dynamic rhytids may produce better results than IPL treatment alone.³

Summing it all up.

IPL treatments are valuable tools for practitioners in the Medical Aesthetics industry, both for their popularity with patients and for their effectiveness and versatility. Having a basic understanding of IPL is a good start, but credible training and experiences are a must before administering treatments. If this article sparked your interest in light therapy, keep the journey going by expanding your knowledge and expertise with reputable training and education.