Published in Oculoplastics

The Role of IPL/BBL in Oculoplastic Surgery

This is editorially independent content
11 min read

Familiarize yourself with the clinical applications for intense pulsed light (IPL) and broadband light (BBL) treatments in oculoplastic surgery.

The Role of IPL/BBL in Oculoplastic Surgery
Intense pulsed light (IPL) and broadband light (BBL) both use light-based technology to treat a range of skin concerns, including rosacea, sun damage, and hyperpigmentation, as well as dry eyes secondary to meibomian gland dysfunction (MGD).
Both IPL and BBL technologies have some similar applications in oculoplastic surgery.

The history of intense pulsed light

IPL was first developed in the 1990s as a non-invasive alternative to traditional laser treatments for skin rejuvenation and hair removal. The technology works by delivering short pulses of broad-spectrum light to the skin, which is absorbed by melanin or hemoglobin (depending on the filter) and converted to heat energy. This heat energy targets the hair follicle or skin cells, leading to their destruction and eventual removal from the body.
Since its introduction, IPL has become a popular treatment option for a variety of skin concerns, including pigmentation irregularities, vascular lesions, and hair removal. IPL technology has continued to evolve over the years, with new advancements allowing for even greater precision, effectiveness, and patient comfort.

Expanding IPL offerings with broadband light

BBL is a more recent development in light-based skin treatments, first introduced in the early 2000s by Sciton, a manufacturer of medical aesthetic lasers and light-based systems. BBL builds on the technology of IPL, but with some important differences. Unlike traditional IPL, which uses a narrow range of wavelengths, BBL uses a broad range of wavelengths to target multiple skin concerns simultaneously. This allows for greater customization and precision in treatment, as well as faster results.
Additionally, BBL incorporates advanced safety features, such as smart filters that adjust to the patient's skin type and real-time temperature monitoring. Since its introduction, BBL has become a popular and highly effective treatment option for a range of skin concerns, including pigmentation irregularities, hair removal, and acne treatment. The development of BBL HERO has further advanced the technology, offering even greater speed, precision, and patient comfort.

Ophthalmic uses for IPL: MGD and ocular rosacea

IPL has been used to treat meibomian gland dysfunction and ocular rosacea, conditions that lead to dry eyes. The meibomian glands are small glands located in the eyelids that produce the oil that lubricates the surface of the eye. When these glands become blocked or inflamed, it can result in various eye conditions such as dry eye syndrome, meibomian gland dysfunction, and blepharitis.
Light-based therapy can help to improve the function of the meibomian glands, which can enhance the quality and quantity of oil produced, leading to better eye lubrication and improved eye health. The treatment involves applying pulses of light to the skin around the eyes, which can help to unclog the meibomian glands, reduce inflammation, and improve the quality of the tears.
Recent studies have suggested that BBL may also have a role in ophthalmology by treating ocular rosacea and MGD, conditions that affect the eyes and cause dryness, redness, and irritation.

How to use IPL to unclog meibomian glands

IPL/BBL both work by reducing inflammation and improving the function of the meibomian glands, which are responsible for producing the oily layer of the tear film. Dysfunction of the meibomian glands is a common cause of dry eye syndrome, and IPL can help to improve their function by unclogging blocked glands and reducing inflammation.
During the procedure, a protective gel is applied to the patient's eyes, and a handheld device is used to deliver the light pulses to the eyelids and surrounding areas. The treatment is typically done in a series of three to four sessions, with each session lasting approximately 15 minutes.
Both IPL and BBL treatments can be used for Fitzpatrick skin types I to V, and caution must be used when treating skin of color. Light-based therapy is often used in combination with other treatments, such as lid hygiene, warm compresses, and lubricating eye drops, to provide comprehensive care for eye conditions.

Aesthetic applications for oculoplastic surgery

Broadband light and intense pulsed light are both light-based therapies used in aesthetics. They are non-invasive treatments that use various wavelengths of light to address a range of skin concerns. Some of the uses of BBL/IPL in aesthetics are listed below.

Hair removal

BBL/IPL can effectively remove unwanted hair from various parts of the body, including the face, arms, and legs. BBL/IPL works by targeting the pigment in hair follicles. The pigment absorbs the light energy, damaging the hair follicle and inhibiting hair growth. Multiple treatments are typically required for optimal results, and the number of treatments will depend on factors such as hair color, hair thickness, and skin tone.

Skin rejuvenation

BBL/IPL can improve the appearance of sun damage, age spots, freckles, and other pigmentation irregularities. It can also stimulate collagen production and improve skin texture, tone, and elasticity. The treatment works by targeting the melanin in the skin, which absorbs the light energy and is then broken down by the body's natural processes.
Figures 1 and 2 are before and after photographs of a patient with age spots who underwent intense pulsed light treatment.
Figures 1 and 2: Courtesy of Anaïs Carniciu, MD

Acne treatment

BBL/IPL can reduce the inflammation associated with acne and help prevent future breakouts. BBL/IPL can be an effective treatment for mild to moderate acne. The light energy penetrates the skin and targets the bacteria that cause acne, as well as the inflammation associated with acne.

Rosacea treatment

By targeting the blood vessels in the skin, BBL/IPL can reduce the redness associated with rosacea and improve skin quality by targeting the blood vessels in the skin. The light energy is absorbed by the blood vessels, which are then broken down for enhanced skin clarity.
Figures 3 and 4 are before and after photographs of a patient with ocular rosacea who underwent IPL treatment.
Figures 3 and 4: Courtesy of Anaïs Carniciu, MD

Vascular lesions

BBL/IPL can reduce the appearance of broken capillaries, cherry angiomas, and other vascular lesions.
Figures 5 and 6 are before and after photographs of a patient with visible facial vessels who underwent BBL treatment.
Figures 5 and 6: Courtesy of Anaïs Carniciu, MD

Post-surgical healing

BBL/IPL can help reduce the appearance of discoloration and redness associated with scars. BBL specifically has a bruise setting to assist with the resolution of bruising that may occur after cosmetic injectables and surgery.
As with any medical treatment, the effectiveness of BBL/IPL treatments may vary depending on the individual and the severity of the condition being treated.

Risks of IPL and BBL

Like any medical procedure, intense pulsed light and broadband light treatments can have potential complications, although they are generally safe and well-tolerated when performed by a qualified clinician.
Some of the potential complications associated with IPL and BBL include:
  • Skin irritation: After treatment, patients may experience redness, swelling, or sensitivity in the treated area. This is generally mild and temporary, but in some cases, it can persist for a few days.
  • Hyper- or hypopigmentation: IPL and BBL can both cause changes in skin pigmentation, resulting in darkening (hyperpigmentation) or lightening (hypopigmentation) of the treated area. This is more common in patients with darker skin tones and can be permanent in some cases. The risk of pigmentary complications is reduced by selecting settings appropriate for the patient’s Fitzpatrick skin type.
  • Burns: The heat energy used in IPL and BBL treatments can cause burns if the settings are too high or if the skin is not properly protected during treatment. Burns can range from mild to severe and may require medical attention.
  • Scarring: In rare cases, IPL and BBL treatments can lead to scarring or other permanent changes to the skin texture or appearance.
  • Eye damage: IPL and BBL treatments can be harmful to the eyes if proper eye protection is not used during treatment. Patients should always wear protective goggles to prevent ocular damage.
It's important to be open with patients about the potential risks and benefits of IPL or BBL treatments and encourage patients to follow all pre- and post-treatment instructions carefully to minimize the risk of complications. With proper care and attention, IPL and BBL can be safe and effective treatment options for a range of skin concerns.

5 clinical pearls for IPL/BBL treatments

1. Encourage sun protection

It's important to avoid sun exposure before and after IPL and BBL treatments, as this can increase the risk of complications such as hyperpigmentation. Patients should use a broad-spectrum sunscreen with an SPF of 30 or higher and wear protective clothing when outdoors. Direct sunlight exposure, particularly if sunscreen is not used, increases the risk of complications and may affect the effectiveness of the IPL/BBL treatment.

2. Avoid tanning products

In addition to staying out of the sun, patients should avoid spray tans and self-tanning products for at least 2 weeks before and after treatment.

3. Provide proper eye protection

Patients should always wear eye protection (device-appropriate goggles or corneal shields) during IPL/BBL treatments to prevent damage to the eyes.

4. Follow post-treatment instructions

After treatment, patients should follow all post-treatment instructions provided by their clinician, including avoiding sun exposure, using gentle skincare products, and avoiding activities that may irritate the treated area.

5. Customize treatment

IPL and BBL treatments can be customized to address specific skin concerns, skin types, and conditions. It's important to tailor each patient’s settings appropriately to skin type and concern.

Conclusion

IPL and BBL have revolutionized the field of oculoplastic surgery and medical aesthetics, offering a wide range of treatment options for a variety of skin conditions as well as dry eye syndrome.
Anaïs Carniciu, MD
About Anaïs Carniciu, MD

Anaïs Carniciu, MD, is a board-certified ophthalmologist and ASOPRS-trained oculofacial plastic surgeon. She is co-founder of New York Eye and Face Oculoplastic Surgery in Westchester County, NY. Dr. Carniciu also serves as Associate Adjunct Surgeon and member of the teaching faculty at the New York Eye and Ear Infirmary of Mount Sinai. Using a natural approach, Dr. Carniciu is passionate about improving her patients’ confidence and quality of life through cosmetic and reconstructive oculoplastic surgery.

Anaïs Carniciu, MD
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