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Bjørn M, Stausbøl-Grøn B, Braae Olesen A, Hedelund L. Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial. Lasers Surg Med 2013; 46:89-93. [PMID: 24018777 DOI: 10.1002/lsm.22165] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Treatment of acne scars with ablative fractional CO2 laser appears to be an effective and well-tolerated treatment. However, so far the influence of treatment interval has not been evaluated. OBJECTIVE To evaluate whether treatment of acne scars with fractional CO2 laser resurfacing at 1-month interval achieves better results with no difference in the occurrence of adverse effects, than treatment given at 3-months interval. METHODS Patients (n = 13) with symmetrical atrophic acne scars on right and left sides of the mid-face and lower-face were randomized to two fractional CO2 laser treatments at 1-month versus 3-month intervals. Blinded on-site evaluations were performed 1 and 6 months after the last treatment on 10-point scales. Endpoints were scar atrophy, patient satisfaction, and adverse effects. RESULTS Pre-operatively, acne scars were moderately atrophic (5.86 ± 1.87). After treatment acne scars appeared with less atrophy on both treated sides 1 month postoperatively (1-month interval 1.96 ± 1.23, P < 0.0001; 3-months interval 1.82 ± 1.08, P = 0.0006) and 6 months postoperatively (1-month interval 1.56 ± 1.24, P = 0.0021; 3-months interval 1.33 ± 1.66, P = 0.0002). The treatment interval did not influence the improvement of scar atrophy at any time postoperatively (P = 0.81). Patients were moderately and equally satisfied with the treatment result on facial sides (P = 0.93). Postoperative adverse effects were minor and not influenced by the treatment interval. CONCLUSIONS Fractional CO2 laser resurfacing improves atrophic acne scars and a treatment interval of either 1-month or 3-months does not seem to influence the improvement of scar atrophy nor the occurrence of postoperative adverse effects.
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Affiliation(s)
- Marie Bjørn
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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102
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Abstract
Ablative skin resurfacing using the carbon dioxide laser was long considered the gold standard for treatment of photoaging, acne scars, and rhytids. However, conventional full-face carbon dioxide resurfacing is associated with significant risk of side effects and a prolonged postoperative recovery period. Fractional resurfacing has recently revolutionized laser surgery by offering close to comparable results with minimal side effects and a more rapid recovery. Although fractional devices have grown in popularity, and have essentially replaced traditional resurfacing, fractional resurfacing can still be a challenging modality to control precisely due to hardware variations across comparable devices, the range of settings that can be used, and patient-specific considerations. Certain precautions and rules of thumb can reduce the risk associated with fractional resurfacing, and increase the likelihood of a good outcome.
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Affiliation(s)
- Sonia Shah
- Department of Dermatology, Northwestern University, Chicago, Illinois
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103
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Koprowski R, Wilczyński S, Samojedny A, Wróbel Z, Deda A. Image analysis and processing methods in verifying the correctness of performing low-invasive esthetic medical procedures. Biomed Eng Online 2013; 12:51. [PMID: 23758786 PMCID: PMC3685591 DOI: 10.1186/1475-925x-12-51] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/05/2013] [Indexed: 11/10/2022] Open
Abstract
Background Efficacy and safety of various treatments using fractional laser or radiofrequency depend, to a large extent, on precise movement of equipment head across the patient’s skin. In addition, they both depend on uniform distribution of emitted pulses throughout the treated skin area. The pulses should be closely adjacent but they should not overlap. Pulse overlapping results in amplification of irradiation dose and carries the danger of unwanted effects. Methods Images obtained in infrared mode (Flir SC5200 thermovision camera equipped with photon detector) were entered into Matlab environment. Thermal changes in the skin were forced by CO2RE laser. Proposed image analysis and processing methods enable automatic recognition of CO2RE laser sites of action, making possible to assess the correctness of performed cosmetic procedures. Results 80 images were acquired and analyzed. Regions of interest (ROI) for the entire treatment field were determined automatically. In accordance with the proposed algorithm, laser-irradiated Li areas (ROI) were determined for the treatment area. On this basis, error values were calculated and expressed as percentage of area not covered by any irradiation dose (δo) and as percentage area which received double dose (δz). The respective values for the analyzed images were δo=17.87±10.5% and δz=1.97±1.5%, respectively. Conclusions The presented method of verifying the correctness of performing low-invasive esthetic medical (cosmetic) procedures has proved itself numerous times in practice. Advantages of the method include: automatic determination of coverage error values δo and δz, non-invasive, sterile and remote-controlled thermovisual mode of measurements, and possibility of assessing dynamics of patient’s skin temperature changes.
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Affiliation(s)
- Robert Koprowski
- Department of Biomedical Computer Systems, Faculty of Computer Science and Materials Science, University of Silesia, ul. Będzińska 39, 41-200, Sosnowiec, Poland.
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Hsiao PF, Lin YC, Huang CC, Wu YH. Efficacy and safety of a single treatment using a 10,600-nm carbon dioxide fractional laser for mild-to-moderate atrophic acne scars in Asian skin. DERMATOL SIN 2013. [DOI: 10.1016/j.dsi.2012.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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105
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Wang B, Wu Y, Luo YJ, Xu XG, Xu TH, Chen JZS, Gao XH, Chen HD, Li YH. Combination of intense pulsed light and fractional CO2laser treatments for patients with acne with inflammatory and scarring lesions. Clin Exp Dermatol 2013; 38:344-51. [DOI: 10.1111/ced.12010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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106
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Zhang Z, Fei Y, Chen X, Lu W, Chen J. Comparison of a Fractional Microplasma Radio Frequency Technology and Carbon Dioxide Fractional Laser for the Treatment of Atrophic Acne Scars: A Randomized Split-Face Clinical Study. Dermatol Surg 2013; 39:559-66. [DOI: 10.1111/dsu.12103] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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107
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Manuskiatti W, Iamphonrat T, Wanitphakdeedecha R, Eimpunth S. Comparison of Fractional Erbium-Doped Yttrium Aluminum Garnet and Carbon Dioxide Lasers in Resurfacing of Atrophic Acne Scars in Asians. Dermatol Surg 2013. [DOI: 10.1111/dsu.12030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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108
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Eimpunth S, Wanitphadeedecha R, Manuskiatti W. A focused review on acne-induced and aesthetic procedure-related postinflammatory hyperpigmentation in Asians. J Eur Acad Dermatol Venereol 2012. [DOI: 10.1111/jdv.12050] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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109
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Sardana K, Garg VK, Arora P, Khurana N. Histological validity and clinical evidence for use of fractional lasers for acne scars. J Cutan Aesthet Surg 2012; 5:75-90. [PMID: 23060702 PMCID: PMC3461801 DOI: 10.4103/0974-2077.99431] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Though fractional lasers are widely used for acne scars, very little clinical or histological data based on the objective clinical assessment or the depth of penetration of lasers on in vivo facial tissue are available. The depth probably is the most important aspect that predicts the improvement in acne scars but the studies on histology have little uniformity in terms of substrate (tissue) used, processing and stains used. The variability of the laser setting (dose, pulses and density) makes comparison of the studies difficult. It is easier to compare the end results, histological depth and clinical results. We analysed all the published clinical and histological studies on fractional lasers in acne scars and analysed the data, both clinical and histological, by statistical software to decipher their significance. On statistical analysis, the depth was found to be variable with the 1550-nm lasers achieving a depth of 679 μm versus 10,600 nm (895 μm) and 2940 nm (837 μm) lasers. The mean depth of penetration (in μm) in relation to the energy used, in millijoules (mj), varies depending on the laser studied. This was statistically found to be 12.9–28.5 for Er:glass, 3–54.38 for Er:YAG and 6.28–53.66 for CO2. The subjective clinical improvement was a modest 46%. The lack of objective evaluation of clinical improvement and scar-specific assessment with the lack of appropriate in vivo studies is a case for combining conventional modalities like subcision, punch excision and needling with fractional lasers to achieve optimal results.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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110
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Sobanko JF, Alster TS. Management of acne scarring, part I: a comparative review of laser surgical approaches. Am J Clin Dermatol 2012; 13:319-30. [PMID: 22612738 DOI: 10.2165/11598910-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acne scarring is the result of a deviation in the orderly pattern of healing and can have profound psychosocial implications for patients. While the most effective means of addressing acne scarring is to prevent its formation through good acne control, there are a number of therapeutic interventions that improve the appearance of acne scars. Many of these procedural modalities have flaws and are limited by operator skill and experience. Laser scar revision, on the other hand, is a precise, well tolerated procedure with clinically demonstrable efficacy and minimal adverse effects that may be used alone or in combination with other scar treatments. The last 20 years has seen a dramatic evolution in laser treatment of acne scars, spanning ablative and nonablative technologies, to the current popularity of fractional laser scar revision. Determining which laser system to use depends upon the type and severity of acne scarring, the amount of recovery a patient can tolerate, and the ultimate goals and expectations of each patient. The importance of proper acne scar classification, laser scar revision techniques, and the evidence that addresses each laser system is reviewed in this article.
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Affiliation(s)
- Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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111
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Goodman GJ. Treating Scars: Addressing Surface, Volume, and Movement to Expedite Optimal Results. Part 2: More-Severe Grades of Scarring. Dermatol Surg 2012; 38:1310-21. [DOI: 10.1111/j.1524-4725.2012.02439.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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112
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Gold MH, Biron JA. Treatment of acne scars by fractional bipolar radiofrequency energy. J COSMET LASER THER 2012; 14:172-8. [DOI: 10.3109/14764172.2012.687824] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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113
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Campolmi P, Bonan P, Cannarozzo G, Bassi A, Bruscino N, Arunachalam M, Troiano M, Lotti T, Moretti S. Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology. ScientificWorldJournal 2012; 2012:546528. [PMID: 22593693 PMCID: PMC3347966 DOI: 10.1100/2012/546528] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 01/04/2012] [Indexed: 12/01/2022] Open
Abstract
The CO2 laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO2 laser delivery system and the newer “superpulsed” and scanned CO2 systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO2 laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.
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Affiliation(s)
- Piero Campolmi
- Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Villa S.Chiara, Piazza Indipendenza 11, 50129 Florence, Italy
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Perez M. Commentary on treatment of acne scars in Asian Patients using a 2,790-nm fractional yttrium scandium gallium garnet laser. Dermatol Surg 2011; 37:1470-2. [PMID: 22092942 DOI: 10.1111/j.1524-4725.2011.02116.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee HS, Lee DH, Won CH, Chang HW, Kwon HH, Kim KH, Chung JH. Fractional Rejuvenation Using a Novel Bipolar Radiofrequency System in Asian Skin. Dermatol Surg 2011; 37:1611-9. [DOI: 10.1111/j.1524-4725.2011.02134.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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117
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Kim S. Treatment of Acne Scars in Asian Patients Using a 2,790-nm Fractional Yttrium Scandium Gallium Garnet Laser. Dermatol Surg 2011; 37:1464-9. [DOI: 10.1111/j.1524-4725.2011.02050.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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118
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119
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Laser Treatment for Improvement and Minimization of Facial Scars. Facial Plast Surg Clin North Am 2011; 19:527-42. [DOI: 10.1016/j.fsc.2011.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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120
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Wollina U, Goldman A. Minimally invasive aesthetic procedures in young adults. Clin Cosmet Investig Dermatol 2011; 4:19-26. [PMID: 21673871 PMCID: PMC3108279 DOI: 10.2147/ccid.s17467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Indexed: 11/23/2022]
Abstract
Age is a significant factor in modifying specific needs when it comes to medical aesthetic procedures. In this review we will focus on young adults in their third decade of life and review minimally invasive aesthetic procedures other than cosmetics and cosmeceuticals. Correction of asymmetries, correction after body modifying procedures, and facial sculpturing are important issues for young adults. The implication of aesthetic medicine as part of preventive medicine is a major ethical challenge that differentiates aesthetic medicine from fashion.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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