There is no one device that does everything well. That really is my Commandments 1, 2 and 3. When adding laser surgery to your practice, instead of trying to do it all and being a jack-of-all-trades and a master of none (which I think is a recipe for disaster), find the one thing that you really want to treat and find the one laser that treats that thing most effectively and safely, and buy it.

My philosophy of using lasers to treat skin is to use the specific laser that is optimal for the given condition I’m treating. A single patient may be treated by three different lasers in an initial visit, if I feel that’s the optimal approach. For example, I could use one laser for treating linear veins, a different setting for diffuse redness and yet another laser for remodeling the architecture of the skin, like the wrinkles or the pore size and helping to get skin tightening. Finally, yet another laser to treat the brown spots. I do not believe the principle of purchasing one device and using it to treat all cosmetic conditions. I feel that enough things are working against you, including the biology of a patient and the difficulty of what you’re trying to accomplish, that it doesn’t pay to use anything but the absolute single optimal device for a given condition. I use only lasers and nitrogen plasma in my practice and I do not use IPLs (bright lights that are filtered in an attempt to approximate a laser).

I think IPLs are attempting to be a jack-of-all-trades and master of none, and believe that they are harder to use than lasers and less predictable in their results (despite marketing from companies to the contrary). In addition, I do not like using these devices around the eye, and think it is difficult for the laser user to protect their own eyes from these devices. This is despite them being the true market leaders. Can they be used to treat brown spots (I think they do this very well) and unwanted blood vessels?—absolutely. Are they the best choice-not in my opinion –for the above reasons. Finding the right laser surgeon also means finding one that shares the patients’ philosophy of treatment-so my method is my way and is not for everyone.

In my opinion the long-pulsed Nd:YAG laser is often sold as the laser equivalent to the IPL, billed as being able to treat all kinds of blood vessels, red ones and blue ones, able to perform skin tightening, treat scars as well as treating hair. I believe it’s quite effective for treating larger blue blood vessels in the lower extremity, however I don’t use it for that. In my office I use the long pulse YAG laser for hair removal in dark-skinned or tanned patients, and find it indispensable for this purpose.