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DURHAM, N.C. -- A new laser system that combines four different lasers in one unit is a more effective and safer way to remove birthmarks, broken blood vessels, moles, tattoos and other blemishes than previous lasers, according to a dermatologist at the Duke University Medical Center.

Dr. Robert Clark said the laser system does a more complete job of removing the pigment from skin, and there is less scarring and bruising than with existing lasers, most of which are themselves fairly new. Laser technology is advancing so rapidly that new, more precise lasers are developed every few years, Clark said.

Prior to the introduction of cosmetic lasers in the early 1990s, blemishes were removed either surgically or through chemical peels and a sanding process called dermabrasion. The VersaPulse Laser System is the latest cosmetic technology and the first to incorporate four different lasers into one unit. Clark said a dozen are now in use across the nation with two in the Carolinas -- at Duke and at the North Carolina Plastic Surgery Center in Greensboro.

The benefit of combining lasers is that doctors can quickly switch from one laser to another if the blemish requires a different light wavelength -- the mechanism by which lasers penetrate the skin and disperse the color.

A light touch to an icon on the computer screen allows the doctor to change from one laser to another, said Clark, who is training other doctors around the country on proper usage of the new system.

More than 175 Duke patients have been treated with the Versapulse Laser System, and results have demonstrated that it is, in fact, more efficient and less painful than other lasers, Clark said. Patients experience almost no bruising, compared with up to two weeks of bruising with previous laser treatments. This means doctors can begin subsequent laser treatments within two weeks of the previous session instead of the usual one or two-month interval associated with other lasers.

The greater precision and efficiency of the VersaPulse laser is due, in part, to the use of crystals instead of dyes, said Clark. Older lasers use different colored dyes to achieve the various light wavelengths needed to penetrate the skin and disperse color. But the dye lasers produce a beam of light at such a high energy level that they often cause trauma to both the treated area and the surrounding skin. That trauma results in bruising and, in some cases, scarring.

The crystal lasers are more efficient than dye lasers in one of two ways. Some of them use a shorter wavelength of light -- say, for example, 532 nanometers versus 585 nanometers -- so there is less damage to the skin. Other crystal lasers produce more rapid pulses of light that shorten the amount of time the laser beam is focused on the skin. This "Q-switched" pulsing mechanism gives the skin time to relax and recover in between pulses of light.

"Q-Switching allows us to use much higher energy levels but for shorter time intervals, so the skin is allowed to recover from that damage before the next pulse of energy hits," Clark said. "Recovery is important because it minimizes the spread of heat and thus the chance of scarring."

Three of the four lasers in the new system use this Q-switched mechanism, Clark said. The fourth laser, used to treat vascular or red-colored lesions, is an improvement over its dye-laser predecessor because it produces light energy at a shorter wavelength: 532 nanometers versus 585 nanometers, he said. The shorter wavelength targets a different part of the blood vessel so that instead of exploding red blood cells, it clots off the blood vessel. The body's scavenger "macrophages" then clear out the damaged vessel. The dye laser, on the other hand, produces light energy at such a high level that it causes red blood cells to explode. The red blood cells then leak outside the blood vessel, creating a bruise.

For patients, the benefits of the VersaPulse Laser System are numerous. Because there is less trauma to the tissue, patients feel less pain. And they get quicker results because of the shortened treatment period. In addition, the treatments cost less because there are no toxic dyes or chemicals to continually replenish or to dispose of in federally approved toxic waste sites.

Clark said the cost of the entire VersaPulse Laser System is approximately $225,000, whereas the four separate lasers would cost nearly double that amount.