Following the death of the inventor of the laser, Charles Townes, Dr Patrick Treacy looks back at the history of this groundbreaking technology and examines how its use in aesthetics has evolved. Dr Patrick Treacy is CEO Ailesbury Clinics, chairman of the Irish Association of Cosmetic Doctors and Irish regional representative of the British College of Aesthetic Medicine (BCAM). He is also president of the World Trichology Association. Dr Treacy has won a number of awards for his contributions to facial aesthetics and hair transplants including the AMEC Award in Paris in 2014. Dr Treacy also sits on the editorial boards of three international journals and features regularly on international television and radio programmes. He is scientific committee for AMWC Monaco 2015, AMWC Eastern Europe 2015, AMWC Latin America 2015, RSM ICG7 (London) and Faculty IMCAS Paris 2015 and IMCAS China 2015.

1. 62 Aesthetic Medicine • March 2015
LASERS www.aestheticmed.co.uk
B O D Y

2. I
was watching television on January 27 when the news
broke that Charles H Townes, the Nobel Prize-winning
physicist credited with the invention of the laser and its
predecessor, MASER, had died in Oakland, California at
the age of 99. A visionary physicist, whose research in
thefieldoflasersjointlywonhimandtwoRussianscientists
the 1964 Nobel Prize in Physics. Townes contribution to
everydaylifewasimmeasurable.Hisworkmadeitpossibleto
notonlymeasuretimeprecisely,surveyplanetsandwitness
thebirthofstars,butalsotoplayCDsandscanpricesatthe
supermarket.IwonaYoungScientistAwardwith
studies about lasers while still in my teens
and have written articles about him in
the past, including one for the original
version of this publication 10 years
ago, so it is fitting to be able to
honour his long contribution
to modern communications,
medicine, astronomy and even
weapons systems here.
Charles Townes was born
in Greenville, SC, in 1915. He
studiedatDukeUniversitybefore
completing his PhD at Caltech
in 1939. A stint at Bell Labs was
followed by a faculty position at
Columbia University, where he taught,
before moving to MIT in 1961 and
finallytoBerkeleysixyearslater.
It is ironic now to think that
in 1958, when Townes showed that a MASER
could theoretically be made to operate
in the visible region of the spectrum, his
colleagues told him “that his work would
have little relevance to the real world”.
Four years later Townes received the
Nobel Prize in Physics.
Today,lasersareusedineveryaspect
of life including an ever increasing
number of cosmetic treatments for a
wide range of indications such as skin
resurfacing for wrinkle reduction and
acne scars, removal of tattoos, removal
of hair, removal of pigmented blemishes
(age spots and moles) and the treatment
of vascular lesions (port wine stains and
spider veins).
Therealstoryoflasersstartedmanyyears
before Townes research however. In the
year of 1917, the great physicist, Albert Einstein postulated
that atoms could be persuaded to emit tiny packets of
energy called “photons” in his treatise “On the Quantum
Theory of Radiation.” This sentinel piece of physics laid
the groundwork for the theory of stimulated emission of
radiation,whichwaslaterusedbythebyAmericanphysicist,
Gordon Gould to coin the acronym LASER. In essence, the
word is an abbreviation of the phrase light amplification by
stimulated emission of radiation. The year was 1957 and the
Russians had just launched Sputnik 1 into the skies above
a horrified US nation. Senator Lyndon Johnson
spoke for the nation when he said “soon,
they will be dropping bombs on us from
space like kids dropping rocks onto
cars from freeway overpasses!”
In that year, plans were made
to start the space race and
America ushered in a new age of
political, military, technological,
and scientific developments.
The Government formed the
Pentagon’s Defense Advanced
Research Projects Agency and
huge grants were poured into
private and public laboratories
across the United States to fund the
creation of a new spacecraft and the
first working laser. In 1960, their efforts
paid off when a physicist called Theodore
Maiman,workingwiththeHughesElectricCorporation
in California, created the world’s first working Ruby laser.
The acronym LASER, although appearing theoretical, is of
more than passing interest because it means a laser device
must be able to make a new form of light. This light must be
composed of one wavelength (colour), it must pass in one
direction (coherent) and its waves must be parallel. These
unique characteristics can be used by doctors to achieve
different results.
Weknowthedifferentwavelengthscanpenetratevarious
depths of skin and they can also cause dissimilar effects by
targeting differing coloured lesions. This means that laser
A could be used to target haemoglobin (red) in the broken
blood vessels (telangiectasia) of rosacea, while laser B may
be used to target melanin (brown) in the hair on an upper
lip of a female with hirsutism. It also means that lasers
could be used to vaporise water in tissues, thereby causing
resurfacing and later collagen stimulation with significant
improvements to wrinkles in the skin.
In 1961, research was focused on this new technology
63Aesthetic Medicine • March 2015
LASERS
B O D Y
www.aestheticmed.co.uk
Following the death of the inventor of the laser, Charles
Townes, Dr Patrick Treacy looks back at the history
of this groundbreaking technology and examines how
its use in aesthetics has evolved
Laser days
It is ironic now to think
that in 1958, when Townes
showed that a MASER could
theoretically be made to operate in
the visible region of the spectrum,
his colleagues told him “that his
work would have little relevance
to the real world”
Charles Townes (left), inventor of the laser

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LASERS
Aesthetic Medicine • March 2015
continued with the production of a new laser made from
crystals of yttrium-aluminium-garnet treated with 1-3%
neodymium. The world’s first Nd:YAG laser was developed.
This laser emitted energy in the near infrared (IR) spectrum
at a wavelength of 1060nm. Although many Americans felt
safertohavemorepowerfullasersbeingdeveloped,doctors
triedtoharnessitspowerastheyfounditshigh-penetration
emission to be useful for vapourising tissues and thermally
coagulating large blood vessels. It is interesting to see that
the laser is still widely used in cosmetic medicine today. It
has even found a new role targeting hair follicles in darker
coloured skin.
Thefollowingyear,thefirstexperimentsintodepilationby
lasertookplacewhenDrLeonGoldmanusedtheprincipleof
selective target destruction with Ruby lasers in an attempt
to destroy the melanin in hair follicles. Unfortunately for
him,althoughtheideawasgood,hedidnottakeintoaccount
that the laser emitted a continuous wave more adept at
shooting down Sputnik and it also targeted melanin in the
skin and burnt his patients. The other patients
in the experiment suffered from post
inflammatory hyperpigmentation and
the experiment was abandoned.
In that year, the Argon laser
was also developed. This
laser emitted energy in the
blue-green portion of the
visible spectrum, making it
more readily absorbed by
melanin and haemoglobin
than by the surrounding
tissue.
In 1963, the Ruby
laser became the first
medical laser when
Francis L’Esperance from
the Columbia- Presbyterian
Medical Centre used it to
coagulate retinal lesions. In 1965 he
began working with Bell researchers
Eugene Gordon and Edward Labuda
to design a better laser for eye
surgery as the blue-green light of the Argon laser is more
readily absorbed by blood vessels than the red light of the
Ruby laser. After further refinements and experiments,
they developed a laser that is still used to this day to treat
patients with diabetic retinopathy. It also has a use in the
treatment of port-wine stains.
As the cold war developed, the US Government funded
projects that covered research into more powerful lasers,
ones that had the power to cut through steel. In 1964, Patel
at Bell Laboratories developed the CO2
laser. This laser
operated at 10,600nm and it was similar to the Nd YAG
in that it could be used for cutting materials like stainless
steel. The advantage was that it could also be focused onto
a smaller spot; a function that one day could be useful in
space.Thankfullyforcosmeticmedicineatthiswavelength,
energy is also heavily absorbed by water, which everyone
knows is the primary constituent and chromophore of
cells in living tissue. This particular function made the
energy generated by the new CO2
laser suitable for tissue
vapourisation and a whole new era of wrinkle removal by
skin resurfacing began. The experiments on trying to find
the “Holy Grail” of being able to remove hair by laser light
followedthepathoftheemergingBeatlesthroughoutmost
of the rest of the sixties. In 1967, while Dr Chris Barnard
carried out the world’s first human heart transplantation
at the Groote Schuur hospital in Capetown, attempts
made to reduce the potential damage to background skin
by directing the light energy to individual follicles through
the use of a wire-thin fibre optic apparatus. Many of these
devices were sold illegally in the United States throughout
the late sixties until the FDA banned their use.
In 1968, Union Carbide’s commissioned a study by
Dermascan (manufacturer of the Proteus thermolysis
machine) of the effects of applying laser energy applied
directly to each hair follicle. The results were largely
unsuccessfulinthattheperceiveddepilationmayhavebeen
related to a type of electrolysis effect. Today the company
is more famous, for those three nights in 1984, when their
chemical plant in Bhopal, India, began leaking 27 tons of
the deadly gas methyl isocyanate into the atmosphere
exposing half a million people to the gas, resulting
in the eventual deaths of 20,000 people.
During the 1970s research continued
into finding a laser for hair removal
with Omnicron Corporation
producing a photo epilator
that used coherent light
to epilate hair. The device
never produced marketable
results and things
remained that way until
another attempt was by
Lasertron Inc. in the 1980s
when they used an Argon
laser to direct energy at the
haemoglobin surrounding
individual hairs. The device
was marketed before proper
clinical tests were done to
establish its efficacy and before
long patients were complaining
as it proved to be unsuccessful for
permanent hair removal. In 1983, Oshiro and
Maruyama noted that hair was lost from after pigmented
nevi were treated with a Ruby laser. Whenever they
increased the laser power to affect the hair follicles, the
epidermis became severely damaged. These observations
led to Anderson and Parrish developing the theory of
“selective photothermolysis”. This theory was based on
the fact that a laser of particular wavelength and pulse
duration of light could be used to target a particular
chromophore, selectively destroying it while sparing the
surrounding tissue.
While tumultuous things were happening on the world
stage, including the fall of the Soviet Empire, the freeing of
Nelson Mandela and Saddam Hussein’s fateful annexation
of Kuwait, the development of laser hair technology
seemed to have reached an impasse. There were some
highlights when ThermoLase Corporation built and tested
a low-power Nd:YAG laser for the removal of tattoos and
birthmarks. During the mid-nineties the quest to find the
Holy Grail laser seemed to quicken when ThermoLase
used a topical suspension of carbon particles applied to
skin followed by treatment of a Q-switched variant of this
In
1995, the world
was gripped by the live
television coverage of the
Los Angeles trial of a former
American football star and actor
‘O.J.Simpson’. Further upstate
in the small town of Los Gatos,
dermatologist Patrick Bitter had
other things on his mind. He was
starting clinical trials on a new
high intensity light device
called an IPL recently
invented by Israeli
In 1995, the world was
gripped by the live television
coverage of the Los Angeles trial of a
former American football star and actor
‘O.J.Simpson’. Further upstate in the small
town of Los Gatos, dermatologist Patrick
Bitter had other things on his mind. He
was starting clinical trials on a new high
intensity light device called an IPL
recently invented by Israeli scientist,
Dr Shimon Eckhouse PhD

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Nd:YAG laser called the SoftLightTM
to treat hair. The laser
certainly produced some results and within a short time it
received FDA approval and became the first device for hair
removal in the United States. ThermoLase went all out to
market the product and within a short period they starting
using the device in a chain of clinics called Spa Thira. It
soon became apparent that this was not the “Holy Grail”
laser as the device seemed to only delay hair regrowth by
three to four months, but it did not provide permanent hair
reduction. This led to several lawsuits against the company
and in the period 1998-99, they closed most of their spas.
However, all was not lost for ThermoLase, because it is
apparent that many clients who had unsuccessful hair-
removal reported improvement in their skin’s texture. It
appeared the heat emitted by the laser in association with a
lotion that was employed caused a form of skin resurfacing.
Before long, Thermage exploited this benefit by obtaining
FDA approval for SoftLightTM
resurfacing, marketing it
as a safe, fast and effective alternative to CO2
and erbium
skin resurfacing.
In 1994 doctors Anderson and Grossman, working with
Palomar Medical Technologies, first used a water-cooled
delivery handpiece during epilation with a long pulsed
Ruby laser. The laser was developed at Massachusetts
General Hospital and the chilled head meant the laser did
not thermally damage the surrounding skin, leaving it less
irritating than other methods and relatively pain free. This
RubylaserandthelaterEpiLight®
pulsedlightlaserareboth
still in use in many US clinics today.
In 1995, the world was gripped by the live television
coverage of the Los Angeles trial of a former American
football star and actor OJ Simpson. Further upstate in
the small town of Los Gatos, dermatologist Patrick Bitter
had other things on his mind. He was starting clinical trials
on a new high intensity light device called an IPL recently
invented by Israeli scientist, Dr Shimon Eckhouse PhD.
Eckhouse postulated that if one used a Xenon flashlight
to emit light made up of multiple wavelengths and then
applied cut-off filters to restrict the bandwidth to a certain
range, he could imitate laser action by using the shorter
wavelengths to clear pigment spots (lentigines) and broken
vessels (telangiectasias) and the longer ones rejuvenate
and smooth the skin. By using a range of wavelengths and
some clever software Eckhouse produced a device that
could cure many ailments at once. In these moments the new
conceptsofIntensePulsedLight(IPL)andphotorejuvenation
werebornandwithBitter’sclinicaltrialsgettingFDAapproval,
theworldmovedclosertofindingtheHolyGraillaser.

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Ironically, these devices would not be real lasers, as they
were in reality flash lamps giving off white light, similar to
that of a light bulb with wavelengths in the range of 400-
765nm. In 1998, ESC Sharplan announced the introduction
of the Vasculight®
and the concept of IPL®
technology for
photorejuvenation. In the year 2000, this company became
LumenisandtheyintroducedtheQuantumSRasthepioneer
IPLofthenewTypeIPhotorejuvenationprocedure.By2001,
around the time of the attack on the World Trade Centre,
numerous companies had begun to produce IPL machines
and market the photorejuvenation procedure. Later that
yearsomeofthepeoplewhohadhelpedformESC/Lumenis
scientists created a new company called Syneron.
In 2002, this company announced the introduction of the
Aurora RF, a new type of laser that promised to enhance
photorejuvenation by using the addition of RF (bipolar
radiofrequency) to the pulsed light source. This action
brought both companies into the US District Court with
Lumenis bringing a preliminary injunction against Syneron’s
sale of Aurora devices.
In 2004, Lumenis granted Syneron unlimited non-
exclusive worldwide licenses for Lumenis patents relating
to the use of incoherent light in aesthetic and medical
applications, including all of its IPL related patents.
Meanwhile, patients continued the trend of seeking
less invasive procedures with lower downtime and
associated risks. This was balanced by a whole new era of
radiofrequency devices and the introduction of computer
pattern generators and fractionalised resurfacing. But
before we enter this era, we should digress again a little
to the wonderful more innocent world of the twentieth
century.
During the nineties, CO2
laser resurfacing was
considered the cosmetic dermatology “gold standard” for
the treatment of acne scarring, deep rhytids and photo-
damaged facial skin. It was one of the earliest gas lasers to
bedeveloped(inventedbyKumarPatelofBellLabsin1964).
The laser produced a beam of infrared light
with a wavelength around 10, 600nm
and because they operated in
the infrared, special silvered
mirrors and windows made
of either germanium or zinc
selenide were necessary
for their construction.
In 1995, the device
gained popularity within
medicine as physicians
like professor Nick
Lowe stated ultrapulsed
CO2
laser was the most
effective modality for
repairing photo-damaged
skin. Although the laser
quickly gained prominence, it
had considerable post- procedural
problems, including prolonged post-
operative recovery, pigmentary changes and a
high incidence of infective adverse side effects
such as acne flares, fungus and herpes simplex
virus (HSV) infection. Many patients also
complained of oedema, burning, and erythema
that sometimes lasted for many months. The
In
2004, as
NASA’s MER-A
(Spirit) landed on
the surface of Mars,
radiofrequency devices such
as Polaris®
and Thermage®
arrived, promising non-
invasive treatments that
delivered tighter skin,
renewed facial
contours and
In 2004, as NASA’s
MER-A (Spirit) landed on the
surface of Mars, radiofrequency
devices such as Polaris®
and
Thermage®
arrived, promising non-
invasive treatments that delivered
tighter skin, renewed facial
contours and healthier collagen
after a single treatment

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delayed healing, the implied risks and long downtime made
many patients reluctant to accept this method.
For a period, other physicians like professor David
Goldberg favoured the use of Erbium YAG devices to
minimise this side effects. These new solid-state lasers
used a lasing medium composed of erbium doped yttrium
aluminium garnet (Er:Y3Al5O12) and they emitted a
wavelength of 2940 nm, which is infrared light. Unlike
similar Nd-YAG lasers, the output of an Er:YAG laser was
strongly absorbed by water, which limited its use in surgery,
where water is present. Consequently, they were mostly
used for acne scarring, deep rhytids and melasma. In
addition to being absorbed by water, the output of Er:YAG
lasers was absorbed by hydroxyapatite, which made it a
good laser for cutting bone as well as soft tissue.
In 2004, as NASA’s MER-A (Spirit) landed on the surface
of Mars, radiofrequency devices such as Polaris® and
Thermage®arrived,promisingnon-invasivetreatmentsthat
deliveredtighterskin,renewedfacialcontoursandhealthier
collagen after a single treatment. In fact, I did some of the
original research for Syneron at Ailesbury in that year.
But the biggest revolution in lasers was about to arrive.
One year later Reliant Technologies introduced the first
Fraxellaseronthemarket.Thedevicetookitsnamefromthe
factthatitworkedononlyafractionoftheskin’ssurface,thus
creating a pattern of pinpoint burns (microzones) of injury in
the skin that were surrounded by normal intervening skin
that rapidly healed the injured tissue. Only about 15 to 20%
of the skin was affected and the relatively light burn healed
within a few days, eliminating the prolonged downtime
of previous resurfacing lasers. The technique was called
fractional thermolysis.
Non-sequential fractionalised technology had arrived
withitsbenefitsoffasterrecoverytime,moreprecisecontrol
of ablation depth, and reduced risk of post procedural
problems. The obvious benefits of these lasers led to many
newfractionalresurfacinglasersreachingthemarketatthe
same time and there was a growing realisation, by both
doctors and patients, that the much hyped radiofrequency
typenon-ablativemethodsthatappearedafewyearsbefore
were not comparable with ablative skin resurfacing and are
often subject to extravagant claims in terms of efficacy.
In 2006, Lumenis released the ActiveFx as an upgrade of
the Ultrapulse Encore with smaller spot size and a new CPG
giving a random pattern reducing the possibility of having
severaladjacentspotswithresultantheataccumulation.This
wasfollowedbytheDeka30WSmartXideDOT.Manyothers
followed with newer versions including Fraxel themselves
moving into the CO2
wavelength with their Fraxel Repair.
These new fractionalised CO2
lasers substantially
reduced the high level of non-responders seen with quite
expensive non-ablative RF type treatments that in reality
often required multiple painful sessions. The adoption of
the newer fractionalised C02
lasers by many physicians also
reduced the morbidity associated with this type of laser
treatment as the stratum corneum remained intact during
treatment and acted as a natural bandage allowing the skin
tohealmuchfaster.Therearepresentlyseveralhigh-energy,
fractionalised carbon dioxide (CO2
) lasers such as Syneron-
Candela’s CO2
RE system currently available for cutaneous
skin resurfacing.
Although each laser system adheres to the same basic
principles there are significant differences between lasers
with respect to tissue dwell time, energy output, and laser
beamprofile.Thesedifferencesmayresultinvariableclinical
and histological tissue effects.
In 2008, scientists began to combine multiple
wavelengths (Alex (755nm) and Nd: YAG (1064nm) for
treatment of “border line” skin types where the Alexandrite
alone may be too aggressive and the Nd:YAG 1064nm alone
not effective enough. This also led to a reduction in pain
when compared to treating with Nd:YAG alone. Cynosure
started experimenting with other uses for their CO2
lasers
and developed the MonaLisa Touch®
an innovative laser
procedure that delivers CO2
laser energy to the vaginal
wall to promote vaginal mucosal revitalisation and a return
to vaginal health. The procedure is performed in an office
environment without the need for anaesthesia and without
painorsideeffects.DekahavealsoadaptedtheirSmartXide
lasers to this new interesting facet of aesthetic medicine.
So today, as we remember Charles Townes, I reminisce
how far technology has come since he was a young scientist
working at Bell Laboratories testing inventions such as
RADARthathadjustbeenhandedoverbyWinstonChurchill
in an effort to save the British Empire.
Today we have many aesthetic lasers that evolved from
his original inventions. We now use Pulsed Dye Lasers
(585/595nm) for port wine stains but KTP, IPL, Nd:YAG and
Alex still remain is use in many centres. Advertisements
show long-pulsed Alex or IPL for superficial lesions such as
lentigines and Q-Switched Nd:YAG 1064nm are widely used
ontattoos.Aplethoraofscienceatourdisposalthatstarted
from the work of this scientist who stuck by his guns when
famous theorists like Niels Bohr and John von Neumann
doubted whether it was possible to create such a thing as a
maser. He continued when Nobel laureates Isidor Isaac Rabi
and Polykarp Kusch tried to stop him: “Look, you should stop
theworkyouaredoing.Itisn’tgoingtowork.Youknowit’snot
going to work, we know it’s not going to work”. They received
the budget for their research from the same source as
Townes and is it documented that only three months before
the first successful experiment, they again approached him
and said “You’re wasting our money, Just stop!”
I am reminded of the words of Winston Churchill
‘success is going from failure to failure without any loss
of enthusiasm’. AM
>> DrPatrickTreacy is CEO Ailesbury Clinics, chairman of the Irish Association of Cosmetic Doctors and Irish
regional representative of the British College of Aesthetic Medicine (BCAM). He is also president of
the World Trichology Association. Dr Treacy has won a number of awards for his contributions to facial
aesthetics and hair transplants including the AMEC Award in Paris in 2014. Dr Treacy also sits on the
editorial boards of three international journals and features regularly on international television and
radio programmes. He is scientific committee for AMWC Monaco 2015, AMWC Eastern Europe 2015,
AMWC Latin America 2015, RSM ICG7 (London) and Faculty IMCAS Paris 2015 and IMCAS China 2015.