Laser's Just a Tool--Not a Magic Wand, Expert Says : Doctor says that it can have miraculous results but that too many people think you can just zap a problem away.

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Can a simple beam of light work miracles?

Yes and no, says plastic surgeon Bruce M. Achauer of Orange.

Achauer, director of the plastic surgery division at the Beckman Laser Institute at UC Irvine and an internationally recognized expert on the subject, says laser light can produce miraculous results in some applications. But not, however, in the types of cases for which it is being most highly touted.

Take laser face-lifts, for example. Some doctors claim in advertisements that using light instead of a scalpel can turn a face lift into a quick, painless procedure that can be completed in a lunch hour and will "take 20 years off your life."

Achauer showed some of those published claims at a luncheon lecture to the UCI Research Associates last week to illustrate how far the misinformation has spread. Unfortunately, it just isn't so, he explained, at least not yet.

"There are a lot of expectations that if you can just shine a laser on something, it's basically magic and all the problems will be taken care of with no scars or side effects. But it doesn't work that way," Achauer said.

"It's possible to bring out the laser in the middle of any operation," said Achauer, who is also associate adjunct professor of plastic surgery at UCI and director of the UCI Medical Center burn center.

"But the laser has some drawbacks. It's more expensive, there's a danger of fire, and everyone has to use protective eye covers, which can make it somewhat harder to see the anatomy."

So far, in the only published research comparing lasers to scalpels in aesthetic surgery, doctors in Palo Alto did a series of eyelid lifts, using a laser on one side of the face and scalpels on the other. "They found no difference in blood loss, bruising, healing or final appearance," Achauer said.

But for some patients with much more serious disfigurement than a few facial wrinkles, lasers can make a dramatic difference, Achauer said.

One-year-old Aaron Zell of Huntington Beach, for example, has been undergoing laser surgeries since he was 10 weeks old to control a strawberry hemangioma birthmark on his face. These types of marks, Achauer said, often begin as tiny spots and then grow rapidly. Mysteriously, they stop growing and disappear after anywhere from a few weeks to a few years, but by then they may leave the face or other parts of the body misshapen and damaged.

"To my husband and me, it was literally like an alien," said Aaron's mother, Susan. "We watched it grow over a weekend."

Now after four laser surgeries, the strawberry birthmark still covers parts of Aaron's face. He'll need reconstructive surgery, but it won't be nearly as extensive as it might have been without the lasers. And Achauer was able to not only to save Aaron's eye from the growth, but possibly his life as well. "It was growing a lot inside his mouth, and he couldn't eat; he almost couldn't breathe," Zell said.

Because he is so young, Aaron hasn't suffered as much psychologically from the birthmark as he would if it lasted into his school years. "He doesn't know there's anything wrong with him," his mother said. "He's really lucky that he could have the surgery so young."

Zell said she had some unrealistic expectations herself about the power of lasers. "I thought it would work immediately," she said. "But it's still a long process. And even now he looks 500% better."

Lasers are also very effective on port wine stain birthmarks, the same type of mark that Soviet President Mikhail Gorbachev has on his forehead.

And yes, Achauer told the UCI associates, he'd be willing to give the Soviet leader free treatment if he wants the mark removed.

Kyle Brown of Alta Loma, nearly 3 years old, doesn't know who Gorbachev is. But Kyle, too, was born with a port wine stain birthmark, and he recently had what may be his final laser treatment to remove it. "Since the laser only does like the end of a pencil, Achauer says he may have missed a few spots that he'll have to go back and fix," said Kyle's father, Ben.

Each of the laser treatments Kyle received over the past 2 1/2 years was relatively easy, his father said. "Other than taking a nap after coming out of the anesthesia, he had no side effects whatever. He didn't even seem to realize what happened to him. He wasn't rubbing his face or anything."

On both children, Achauer used a yellow dye laser, which combines dye with laser light, delivered through a fiber-optic cable to vaporize tissues, raising temperatures from about 37 degrees centigrade to 400 degrees, Achauer explained.

Lasers can also be used to control bleeding through photo-coagulation, raising temperatures from 37 to 65 degrees centigrade, irradiate tissue at low intensities, raising the temperature only about a degree, and disrupt tissues such as cancer cells at the highest intensity, which raises tissue temperatures to as high as 20,000 degrees.

The possibility of developing laser, which is an acronym for light amplification by stimulated emission of radiation, dates back to a 1916 suggestion by Albert Einstein.

Laser is light that is better-organized than normal, with its photons moving in coherent waves rather than random ones. The result is an intensity far brighter than normal light. A light bulb, for example, produces .1 watt per centimeter squared. The sun, by comparison, produces 1,000 watts per centimeter squared, while an argon laser produces 1 billion watts per centimeter squared.

The yellow dye laser is a "magnificent breakthrough" because it can remove unwanted tissue without damaging pigment cells, Achauer said. "When we were using an argon laser just a few years ago, we had scarring. Now we have no scarring."

Achauer is also having success with a redesigned form of an old laser, the Q-switched ruby laser, which uses ultra-short bursts of high-intensity laser energy. That laser is effective in removing tattoos, as well as traumatic tattoo-like markings, such as powder or other foreign matter embedded in the skin due to explosions and other accidents.

Any licensed medical doctor can use a laser in his office without standardized training or certification, Achauer said, although hospitals usually require special training before permitting a doctor to use a laser.

The American Society of Plastic and Reconstructive Surgeons has issued guidelines for the use of lasers, recommending specific training and continuing education for doctors.

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