Plastic Surgery

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Thursday, January 30, 1997

Health: Laser Treatment Makes Its Mark

(January 19) -- If Mikhail Gorbachev ever wished to get rid of his trademark - the large port-wine stain on his forehead - all he would have to do is come to Jerusalem and undergo a $4,500 series of laser treatments. Although the former Soviet president is unlikely to want to part with the red mark he was born with, many other people whose physical appearance is disfigured and self-esteem harmed by congenital or other defects would jump at the chance.

Until recently, the removal or blurring of warts, stretch marks, hemangiomas, cafe au lait marks, port-wine stains and surgical scars was nearly impossible, as plastic surgery and available lasers did not offer an aesthetic solution. But today, advanced lasers, which emit a single optimum wavelength of light, dramatically reduce the risk of scarring, and are safe enough to be used even on week-old babies.

Although such skin problems may have medical implications (they can grow elevated and thicker with age and bleed if rubbed), treating them has so far been regarded by Israel's health system as a purely cosmetic matter. Thus such treatments are not included in the basket of health services offered by the public health funds, and the public hospitals have not invested money and doctor training in this field.

It took a 37-year-old highly trained dermatologist on the faculty of Brown University Medical School in Rhode Island to come on aliya, invest a quarter of a million dollars in equipment, and open his own center in Jerusalem to make such laser treatment available here.

Dr. David Friedman, born in New York and a graduate of Yeshiva University's Einstein Medical School, came on aliya 18 months ago with his wife Ellen and five children. He has just opened the Institute for Dermatologic Laser Surgery and Hair Transplantation at the (private) Jerusalem Medical Center in the Wolfson Tower building overlooking the Knesset.

His array of laser machines, each suited for a different purpose, are not available in any of the capital's prestigious public hospitals or even in any private medical center, and he believes they are unique in the country. (One woman dermatologist is in the process of setting up her own dermatologic laser center in Tel Aviv.)

Professor Arieh Ingber, chairman of the dermatology department at Hadassah-University Hospital in Ein Kerem, says Friedman is a very well-qualified dermatologist using lasers unavailable at Hadassah. In fact, he had wanted Friedman to work for him at Hadassah, but the young physician decided to open up his own center. Ingber says he has plans to launch a similar dermatologic laser center at Hadassah, but still has no approval from hospital management or commitment for funding.

Skin hemangiomas are harmless tumors composed of a mass of blood vessels. One in 10 people are born with them (actually, they appear a week or two after birth) on their face, head or other parts of the body; in a majority of cases, they fade away (50% by age five, 70% by age seven, and 90% by age nine), but not always in an aesthetically pleasing way. Some even grow to the size of a ping-pong ball. Thus, it's best, says Friedman, to perform laser treatment early.

Port-wine stains, like Gorbachev's, are dilated blood vessels that almost never go away. Occurring in three persons out of 1,000, they darken with age and can be very disfiguring, says Friedman. "I pity the child who goes through life with it on his face or arms or legs. It can harm self-esteem. Since they can look like black-and-blue marks, some parents are even stopped in the street, angrily confronted by strangers who ask if they abuse their children. Some people spend an hour each day putting on thick makeup to mask their facial defects."

Friedman's $85,000 black lamp pulse-dye laser, which carries out selective photo-thermolysis, produces enough heat to remove the skin defect without causing scarring. The old-fashioned argon or carbon-dioxide lasers that were used for years for dermatologic defects (and still exist in local hospitals) often cause scarring by destroying too much tissue. Friedman's laser emits light in 415-microsecond bursts as the dermatologist aims it at one spot after another. It is also effective for treating rosacea (permanent red noses or cheeks due to enlarged blood vessels in the skin), spider angiomas on the face (commonly found in young girls), warts, raised surgical scars, psoriasis, leg veins, and stretch marks (especially effective if they are recent) appearing during pregnancy.

Friedman says he's very satisfied with the results on patients with psoriasis (chronic itchy, reddish patches on the skin); they disappear for several years after two or three laser treatments.

Friedman notes that laser treatment of these skin defects feels like a series of rubber-band flicks on the skin. Most patients don't need an anesthetic, except for children, who require a local or general anesthetic, depending on their age and condition.

Friedman's second device is a CO2 Silk Touch Laser, manufactured by Israel's Laser Industries. This is designed for reducing facial wrinkles and treating scars from acne and other problems. The third is a Q-Switch Ruby for cafe au lait stains, sun spots, and tattoos. "It's also good for permanent hair removal and much quicker than electrolysis.

Although there is currently a tattooing fad (especially among young Tel Avivians), studies show that most people with tattoos eventually want to get rid of them. "I have seen penitent Jews who regret their tattoos [which are barred by Halacha], and many secular Jews who have outgrown them. In the US, there are former gang members who are refused employment until they get rid of their tattoos," said Friedman.

But, as the cost of purchasing the laser equipment and replacing them with more advanced models, as well as regular maintenance, are sky high, Friedman's prices are not bargain basement. A tattoo produced by an amateur requires three to six treatments and by a professional five to nine, each of them costing around NIS 650. Removing cafe au lait marks costs NIS 800 per treatment, and one would need two to four of them. Wrinkle removal costs nearly NIS 4,000 for a part of the face and NIS 10,000 for the whole face. Hemangioma removal costs NIS 1,200 to NIS 1,500 per treatment, and one needs two or three.

Yet there may be good news. Friedman is currently negotiating with one health insurer to provide laser treatments for warts, hemangiomas, and other skin problems; despite the "cosmetic" reputation of such treatments, the insurer would like to offer it free to its members.