Laser vs BBL / IPL For Dummies

We spend a lot of time explaining the differences  between treatment with laser and treatment with Broad Band Light (BBL, as known as Intense Pulsed Light, IPL or photofacial) treatments to our patients. Many of them have tried to figure it out on their own by researching it online, but there is so much information put out by so many manufacturers that its easy to get overwhelmed. This article is intended to provide a simplified explanation of what you can accomplish with BBL and what you can accomplish with ablative laser technology. There is a lot more to the field, but this should at least get you started. You can also just remember this and skip the rest: BBL for fixing discoloration, resurfacing lasers for fixing skin texture.

We'll start with a quick discussion of terminology and facts (don't worry - just the basics!), then talk about the conditions that are typically treated, and then come back to specific applications.

A true laser produces a pulse of energy of a single wavelength. Some lasers are very high powered, some are low powered, and some offer a range of power settings.

BBL and IPL and photofacial are three terms for a class of device that is not a true laser- it uses a flash lamp to produce light energy of many wavelengths at the same time. Just like lasers, different devices offer a wide range of power outputs. High-energy treatments create laser-like effects. BBL is Sciton's trademarked name for their IPL machine which is far more powerful and controllable than previous generation IPL devices.

With any of these devices, the higher the energy levels used, the greater the result will be. Along with this, the treatment will be more uncomfortable and the patient will have a longer recovery period afterwards, during which they can be have swelling, peeling or the need to use a vaseline-type recovery balm. There is no device that will create a substantial effect in a single treatment without a recovery period afterwards. As a general rule, the more you invest in initial discomfort and subsequent recovery, the more you will be able to accomplish in a given treatment.

People come to us for to address two basic problems - textural problems, and discoloration problems.

Textural problems include fine lines, wrinkles, acne and surgical scars, enlarged pores, bumpy or "orange peel" texture and overall looseness or laxity.

Discoloration problems include age or sun spots, spider veins, rosacea, melasma, and dark spots from old acne scars or trauma.

Lets talk about textural problems first. All of these problems can be addressed by removing old damaged collagen and/or stimulating new collagen production, which also tightens skin. In the past, a number of laser frequencies were used that could theoretically penetrate down into the lowest layers in the skin and stimulate cells in the deep dermis without requiring much downtime. Unfortunately most gave modest results at best, and those improvements developed slowly after treatment.

The gold standard for addressing textural problems is to carefully and precisely remove damaged collagen and skin. When these grow back, they grow back tighter, with less wrinkles, smaller pores, improved scarring and texture. There is a huge range of treatment intensities, from very very light (one day of recovery) to intense (2 weeks of recovery).

To remove  skin cells, you use a high-energy laser with a wavelength that reacts with water. Since skin cells are 99% water, they turn into steam so fast that it is possible to remove cells with minimal transfer of heat to the cells left behind, resulting in faster recovery times. Newer lasers also allow you to add additional heat to the remaining cells for further collagen production and skin tightening, although doing so will slightly prolong healing (no pain/no gain).

With this type of treatment, the deeper you go, the greater the improvement, but also the longer the recovery time. Treatments can be further customized by the addition of fractional technology. This allows you to treat only a fraction of the skin (typically 5-30%). By doing so, you can go deep, making a real difference in scars and wrinkles (which are based deep beneath the surface), with a shorter recovery, since much of the skin is left intact to heal in more quickly.

So, to further complicate the issue, although ablative lasers will have their primary effect on texture, if you are going deeper to the extent that you remove abnormal melanin, you will have some effect on pigment as well. Still, to keep things simple, the primary effect of ablative lasers is on texture/laxity.

In contrast, the selected light waves used in BBL/IPL interact with color targets in the skin. These color targets can be brown (melanin/sun damage/hair) or red (hemoglobin/spider veins/rosacea). Different filters are used to maximize interaction with the chosen target.

BBL/IPL penetrates deeply through the layers of skin without ablating or removing skin cells. It interacts with the abnormal target, heating it up.

With abnormal melanin or brown pigment, this can result in release of melanin granules by the cells which stored them. The granules then come to the surface where they often form microcrusts and flake off or may be absorbed by the body and fade away. Either way, the result is both reduction in the visible appearance of sun damage as the actual cellular damage. Research suggests that after a series of treatments, the treated skin actually has less damage and is healthier.

With abnormal redness, broken capillaries, rosacea and reddish-purple birthmarks, a different filter is used, resulting of heating of hemoglobin and thus red blood cells in unhealthy vessels near the skin surface. When heated, these vessels can close down, resolving both the appearance of the broken vessels and the flushing and rosacea complications which result from them.

Although BBL/IPL/Photofacial treatments are often described as "no downtime" treatments, this is not necessarily a valid statement. Like any skin treatment, if you do very light BBL treatments, there will be little discomfort with the treatment, little in the way of initial swelling or pigment coming to the surface, but in the end, little results. Using higher intensities, BBL is more uncomfortable and will result in more pigment coming to the surface and can also result in mild to moderate swelling - particularly if the area under the eyes and broken capillaries are treated aggressively. The tradeoff is that more intense treatments give very impressive results.

A skilled provider using a high powered system has multiple variables which can be adjusted, so talk with your physician about what level of improvement you are looking to achieve and whether you would be able to handle looking less than perfect for a few days if it will get you more results.

Finally, just like laser, there is some overlap. Although BBL/IPL gives a primary improvement in pigment - browns and reds as we discussed, it does put heat into the deeper layers of skin. Over time this results in more collagen production. People who complete a series of BBL/IPL usually do note improvement in fine lines and mild improvement in tone and texture. Most commonly, between the collagen and pigment improvement, people note an overall glow or luminosity to the skin. That being said, deeper textural problems like deep wrinkles and scars need laser technologies for significant improvement.

So, which to do?

If your problem is mostly color, BBL is probably your best bet.  If mostly texture, then laser may offer better improvement.

Your ability to fit into your schedule a period of looking less than perfect (can range from spots being more prominent to swelling, to downright scary looking redness, oozing and peeling). As a general rule, the worse you can handle looking, the more you can accomplish in a single treatment. Laser treatment will generally leave you with more downtime than BBL, although a very light laser treatment can have less downtime than a very intense BBL.

Finally, this isn't all either-or. Most people have some combination of pigment and textural issues and are bothered more by one or the other. Laser and BBL treatments can be combined both in a single session for maximal results or done at different times as a patient's budget and schedule allow.  A thorough evaluation of your skin issues and goals and a thoughtful discussion with your skin care physician will let you determine which therapies will give you your very best results.