The fundamental concept of modern-day laser- and light-based therapies relies on the principles of selective photothermolysis. As we learn more about skin and light interactions, it has become evident that additional factors can influence the safety and efficacy of the delivery of photons to desired targets. This is particularly evident in the treatment of darker skin types. Selective photothermolysis can be further enhanced with a novel approach. Photopneumatic therapy manipulates the optical characteristics of the skin by applying pneumatic energy at the time of delivery of light, thereby enhancing the delivery of photons to desired dermal targets. This chapter will discuss the Isolaz device for photopneumatic therapy.

While fractional devices modify the laser for greater safety and efficacy, photopneumatic therapy is the first approach to modify the optics of the skin. When the skin is stretched using upward pressure, blue and green photons, which are otherwise very superficially transmitted, are now able to reach deeper dermal targets. These blue and green photons often have the greatest affinity for a variety of chromophores but are ineffective because of limited depth of penetration. Moreover, because of their greater affinity to melanin, with traditional light and laser devices, they can produce a greater risk of epidermal injury. When a positive pressure of 3 PSI is applied, water evaporates at 60 degrees Fahrenheit and cooling occurs naturally. With photopneumatic therapy, a thin mist of water is applied, allowing for natural cooling of the skin.