OPTIMIZATION OF LASER PARAMETERS IN AESTHETIC DERMATOLOGY: IMPACT OF FLUENCE, PULSE DURATION AND SPOT SIZE IN ND: YAG, IPL AND CUTERA SYSTEMS – A SYSTEMATIC REVIEW

Karina Lewandowska; Lena Jaworowicz; Wojciech Janikowski; Agnieszka Jóźwicka; Aleksandra Stępka; Weronika Plichtowicz- Kordowska; Maria Wieczorek; Ewa Bąkowska

doi:10.31435/ijitss.2(50).2026.5703

Authors

Karina Lewandowska Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0004-5298-1426
Lena Jaworowicz Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0008-4210-7216
Wojciech Janikowski Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0008-4078-9698
Agnieszka Jóźwicka Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0008-1130-1518
Aleksandra Stępka Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0007-5034-0037
Weronika Plichtowicz- Kordowska Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0009-7713-8597
Maria Wieczorek Medical University of Warsaw, Warsaw, Poland https://orcid.org/0009-0000-9951-7509
Ewa Bąkowska Medical University of Lublin, Lublin, Poland https://orcid.org/0009-0007-4135-9748

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5703

Keywords:

Fluence, Pulse Duration, Spot Size, Nd:YAG, IPL, Cutera, Laser Parameters

Abstract

Laser-based therapies are widely used in aesthetic dermatology for the treatment of vascular lesions, pigmentation disorders and skin rejuvenation. Treatment outcomes and safety depend on appropriate selection of technical parameters, including fluence, pulse duration and spot size; however, standardized guidelines remain limited. This study systematically reviews the impact of key laser parameters on clinical efficacy and adverse events, with emphasis on vascular treatments using Nd:YAG, IPL and modern platforms, including Cutera systems.

A literature search in PubMed (2010–2025) identified clinical studies reporting specific laser settings. Fluence was the primary determinant of efficacy, with higher energy improving vascular clearance but increasing the risk of burns and post-inflammatory hyperpigmentation. Pulse duration influenced tissue selectivity, while spot size affected penetration depth and treatment outcomes.

Advanced systems demonstrated improved safety due to enhanced pulse modulation and cooling; however, complications remained linked to improper parameter selection. Optimization of laser parameters is essential for balancing efficacy and safety, and individualized treatment based on lesion characteristics and skin type remains crucial. Further research is needed to establish standardized protocols.

References

Anderson, R. R., & Parrish, J. A. (1983). Selective photothermolysis: Precise microsurgery by selective absorption of pulsed radiation. Science, 220(4596), 524–527. https://doi.org/10.1126/science.6836297

Ross, E. V., & Anderson, R. R. (2002). Laser-tissue interactions. Dermatologic Clinics, 20(1), 1–10. https://doi.org/10.1016/S0733-8635(03)00044-9

Sadick, N. S. (2003). Laser treatment of vascular lesions. Journal of Cosmetic and Laser Therapy, 5(2), 87–95. https://doi.org/10.1080/14764170310001613611

Bevin, A. A., et al. (2003). Variable pulse duration Nd:YAG laser in treatment of vascular lesions. Dermatologic Surgery, 29(7), 697–703.

Babilas, P., Schreml, S., Szeimies, R. M., & Landthaler, M. (2010). Intense pulsed light (IPL): A review. Lasers in Surgery and Medicine, 42(2), 93–104. https://doi.org/10.1002/lsm.20877

Wat, H., Wu, D. C., Rao, J., & Goldman, M. P. (2014). Intense pulsed light in dermatology. Dermatologic Surgery, 40(4), 359–377. https://doi.org/10.1111/dsu.12466

Papageorgiou, P., Clayton, W., Norwood, S., Chopra, S., & Rustin, M. (2008). Treatment of rosacea with intense pulsed light. British Journal of Dermatology, 159(3), 628–632. https://doi.org/10.1111/j.1365-2133.2008.08749.x

Kim, E. H., Kim, Y. C., Lee, E. S., & Kang, H. Y. (2012). Low-fluence 1064-nm Q-switched Nd:YAG laser for melasma. Annals of Dermatology, 24(3), 267–273. https://doi.org/10.5021/ad.2012.24.3.267

Karaca, Ş., Kulac, M., & Erbil, A. H. (2014). Comparison of long-pulsed Nd:YAG laser and IPL in facial telangiectasia. Balkan Medical Journal, 31(3), 250–255. https://doi.org/10.5152/balkanmedj.2014.13120

Kwiek, B., et al. (2015). Guidelines for laser treatment in dermatology. Dermatology Review, 102(4), 345–352.

Bencini, P. L., Tourlaki, A., & De Giorgi, V. (2014). Laser therapy for vascular lesions. Journal of the European Academy of Dermatology and Venereology, 28(6), 709–718. https://doi.org/10.1111/jdv.12156

Mustafa, M. B., et al. (2019). Laser-tissue interaction mechanisms and clinical applications. Journal of King Saud University - Science, 31(3), 347–355. https://doi.org/10.1016/j.jksus.2018.04.001

Bernstein, E. F. (2018). Laser treatment using modern platforms. Lasers in Surgery and Medicine, 50(1), 2–11. https://doi.org/10.1002/lsm.22730

Manuskiatti, W., et al. (2007). Comparative study of vascular lasers in facial telangiectasia. Dermatologic Surgery, 33(4), 443–450. https://doi.org/10.1111/j.1524-4725.2007.33092.x

Alam, M., Gladstone, H. B., & Tung, R. C. (2021). Dermatologic surgery and cosmetic procedures in vascular lesions: Current approaches and laser selection. Dermatologic Clinics, 39(4), 625–637. https://doi.org/10.1016/j.det.2021.05.006

Alster, T. S., & Tanzi, E. L. (2019). Laser treatment of vascular lesions: An update. Dermatologic Surgery, 45(2), 295–303. https://doi.org/10.1097/DSS.0000000000001672

Liew, S. H., et al. (2020). Lasers and light devices for vascular lesions: Current perspectives. Clinical, Cosmetic and Investigational Dermatology, 13, 431–443. https://doi.org/10.2147/CCID.S212939

Tanghetti, E. A. (2020). Optimizing outcomes with laser and light-based devices. Journal of Clinical and Aesthetic Dermatology, 13(2), E53–E60.

Nestor, M. S., et al. (2019). Treatment of vascular lesions using laser and light-based technologies. Journal of Clinical and Aesthetic Dermatology, 12(11), E61–E68.

Tierney, E. P., & Hanke, C. W. (2019). Nd:YAG laser treatment of vascular lesions. Journal of Drugs in Dermatology, 18(5), 442–448.

Lee, H. S., et al. (2021). Clinical efficacy of long-pulsed Nd:YAG laser. Lasers in Medical Science, 36(5), 1023–1030. https://doi.org/10.1007/s10103-020-03160-1

Del Pozo, J., et al. (2020). Intense pulsed light in dermatology: A systematic review. Actas Dermo-Sifiliográficas, 111(5), 379–389. https://doi.org/10.1016/j.ad.2019.07.009

Kassir, M., et al. (2022). IPL in rosacea and vascular lesions. Dermatologic Therapy, 35(3), e15218. https://doi.org/10.1111/dth.15218

Ryu, H. J., et al. (2020). Comparison of IPL and Nd:YAG laser. Lasers in Medical Science, 35(6), 1427–1434. https://doi.org/10.1007/s10103-020-02982-3

Gold, M. H., et al. (2021). Advances in laser and energy-based devices. Journal of Clinical and Aesthetic Dermatology, 14(1), 28–35.

Sadick, N. S., et al. (2022). Emerging technologies in aesthetic dermatology. Dermatologic Clinics, 40(3), 365–377. https://doi.org/10.1016/j.det.2022.03.004

Ibrahimi, O. A., et al. (2019). Complications of laser therapy. Dermatologic Surgery, 45(3), 394–402. https://doi.org/10.1097/DSS.0000000000001694