Do not fret that you felt no improvement after laser treatments. Medical lasers do work - it is just that the right lasers have to be selected for the skin condition that the patient want to address.
There may be some misconceptions about the topic of skin, collagen and breakdown. To answer your question broadly, the way smoking damages the skin is very different from the way lasers or other energy devices ‘damage’ the skin.
Smoking damages the skin in many ways, including destroying collagen, while some laser procedures which aim to build up collagen may involve damaging the skin surface.
Smoking
A puff of cigarette smoke contains a few thousands free oxygen radicals. These free radicals are hyper-reactive oxygen atoms that can wreak havoc in our various body tissues and organs. Besides harming our health, free radicals can damage our skin in the following ways:
- Direct damage to collagen. Collagen fibrils in our skin can be directly damaged by oxygen free radicals. These collagen fibrils are an important component of our skin’s extracellular matrix, which determines the integrity and function of the skin dermis.
- Impaired production. Fibroblasts, the main cells responsible for producing new collagen in our skin, will be modified by the free radicals and result in a much reduced collagen production capacity (up to 40% in studies).
- Amplification of damage. Free radicals are highly reactive, meaning that they can self-perpetuate reactions that they initiated. Studies have also shown that increased degradation of collagen induces more oxidative stress, worsening the direct damage on collagen (point 1), and causes increased protein oxidation of fibroblasts (point 2). [1]
Lasers and energy devices
On the flip side, laser effect of the skin is determined by what we call the selective photothermolysis effect. In short, what this means is:
- Lasers have specific wavelengths, which we can utilize to treat specific skin conditions
- In terms of collagen, some of the devices we can use include:
- Traditional CO2 laser
- 2940nm Erbium:YAG laser
- 1550nm Erbium Glass Laser
- These lasers can target the collagen fibrils in our skin
- They stimulate production of collagen, cause thermal contraction of the dermis, thereby causing skin tightening.
Point to note is that the ‘damage’ that we see in laser treatments is frequently due to the destruction of the epidermis (the top layer of the skin) and upper part of the dermis (second layer of the skin).
Finally, lasers, if done right, do work. If you feel that your laser did not address your concern, it is best to speak with your doctor again.
Hope that helps.
Warmest regards
Dr Heng Wee Soon
[1] Fisher GJ, Quan T, Purohit T, et al. Collagen Fragmentation Promotes Oxidative Stress and Elevates Matrix Metalloproteinase-1 in Fibroblasts in Aged Human Skin. The American Journal of Pathology. 2009;174(1):101-114. doi:10.2353/ajpath.2009.080599.
