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Tsur Shenhav L, Shehade W, Muravnik G, Horovitz T, Artzi O. The Safety and Efficacy of a Dual CO 2 and 1570-nm Hybrid Laser for Periorbital Rejuvenation. Dermatol Surg 2023; 49:479-482. [PMID: 36877122 PMCID: PMC10194056 DOI: 10.1097/dss.0000000000003750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Many modalities are used for periorbital rejuvenation, with a wide range of efficacy and safety. To achieve favorable outcomes with minimal downtime and adverse effects, professionals developed a hybrid laser, which allows simultaneous treatment with 2 wavelengths: fractional ablative and fractional nonablative lasers. OBJECTIVE To evaluate the safety and efficacy of a new hybrid laser for periorbital rejuvenation. MATERIALS AND METHODS This retrospective single-center study includes 24 patients who underwent a single-pass treatment with a CO 2 and 1570-nm hybrid laser for periorbital rejuvenation between 2020 and 2022. Patients' standardized clinical photographs before and after the treatment were assessed by 4 independent physicians for objective improvement. Treatment data, safety, and patients' satisfaction were also reviewed. RESULTS Statistically significant objective improvements were found in all investigated scales with an improvement of 1 to 2 points on each scale. Patients' satisfaction was 3.1/4. Average downtime was 5.9 ± 1.7 days. Most adverse effects were mild to moderate in severity (89.7%), including erythema, crusting, pruritis, edema, and hyperpigmentation. CONCLUSION After a single-pass treatment, the laser generates 26% to 50% improvement in the periorbital area, with a strong safety profile and a relatively simple recovery. Further research is needed to validate the efficacy of this technology compared with more aggressive modalities.
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Affiliation(s)
- Leah Tsur Shenhav
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Waseem Shehade
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gerardo Muravnik
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Tamir Horovitz
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Aljefri YE, Ghaddaf AA, Alahmadi RA, Alkhamisi TA, Alkhunani TA, Samarkandy SJ, Alamri AM. Ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma in the treatment of atrophic acne scars: A systematic review and meta-analysis. Dermatol Ther 2022; 35:e15888. [PMID: 36183145 DOI: 10.1111/dth.15888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR = 2.56, 95% CI 1.37-4.78 and OR = 3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.
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Affiliation(s)
- Yara E Aljefri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Rana A Alahmadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Taif A Alkhamisi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Tala A Alkhunani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Sahal J Samarkandy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Awadh M Alamri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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3
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Gfrerer L, Kilmer SL, Waibel JS, Geronemus RG, Biesman BS. Dermal Micro-coring for the Treatment of Moderate to Severe Facial Wrinkles. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4547. [PMID: 36262685 PMCID: PMC9575956 DOI: 10.1097/gox.0000000000004547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Micro-coring technology (MCT) removes cores of skin without formation of scars, thereby tightening skin and reducing skin wrinkling. The purpose of this study was to evaluate the safety and efficacy of MCT with the dermal micro-coring device for the treatment of facial wrinkles. METHODS This prospective, multicenter clinical trial included fifty-one subjects who underwent MCT treatments of the mid to lower face. The primary study endpoint was change in the Lemperle Wrinkle Severity Scale. Secondary study endpoints were change in Global Aesthetic Improvement Scale (GAIS), participant satisfaction, and evaluation of treatment outcome by an independent review panel. All study endpoints were evaluated at 1, 7, 30, 60, and 150 or 180 days after treatment. Procedure bleeding, pain, and early healing profile were also captured. RESULTS The mean Lemperle Wrinkle Severity Scale change was 1.3 grades. Improvement in the GAIS was reported for 89.7% (87/97) of treated sites, and average improvement of GAIS was 1.5. Participants reported satisfaction with 85.6% of treatment sites. The independent review panel correctly identified 84.2% of the post-treatment photographs as post-treatment. Procedure bleeding and pain was mild with good healing responses and patient-reported average down time of 3 days. CONCLUSIONS The results of this study demonstrate the safety and efficacy of MCT with the dermal micro-coring device for the treatment of moderate to severe facial wrinkles. MCT led to significant improvement of facial wrinkles with high patient satisfaction and fast recovery time and should be considered in patients who are seeking minimally invasive treatment for wrinkles of the face.
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Affiliation(s)
- Lisa Gfrerer
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Suzanne L. Kilmer
- Laser and Skin Surgery Center of Northern California, Sacramento, Calif
| | | | | | - Brian S. Biesman
- Laser and Skin Surgery Center of Northern California, Sacramento, Calif
- Practice of Brian S. Biesman, MD, Nashville, Tenn
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Seirafianpour F, Pour Mohammad A, Moradi Y, Dehghanbanadaki H, Panahi P, Goodarzi A, Mozafarpoor S. Systematic review and meta-analysis of randomized clinical trials comparing efficacy, safety, and satisfaction between ablative and non-ablative lasers in facial and hand rejuvenation/resurfacing. Lasers Med Sci 2022; 37:2111-2122. [PMID: 35107665 DOI: 10.1007/s10103-022-03516-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 01/23/2023]
Abstract
Skin aging inevitably begins from the very early days of life. The lasers used in skin rejuvenation are mainly of two types: ablative and non-ablative. This meta-analysis aimed at comparing ablative with non-ablative lasers in terms of their efficacy and safety in skin rejuvenation. Articles published by March 15, 2020 in Embase, Medline (PubMed), Scopus, Cochrane, and clinicalTrials.gov were searched. The inclusion criteria included randomized controlled clinical trials (RCTs) in English using ablative and non-ablative lasers and comparing their safety and efficiency in wrinkle improvement and photoaging therapy. Out of 1353 extracted articles, 11 were selected for qualitative synthesis and of these, 4 were quantitatively analyzed. Different modes of various lasers were implemented; the ablative lasers included Erbium: yttrium-aluminium-garnet (Er:YAG) and CO2, besides the non-ablative lasers, comprised Ytterbium/Erbium, Erbium: Glass, neodymium: yttrium-aluminum-garnet (Nd:YAG), and alexandrite. Pooled analyses on 124 participants showed insignificant differences between ablative and non-ablative lasers in the likelihood of excellent improvement with an odds ratio of 0.83 (95% CI: 0.24, 2.83). The analyses also showed good improvement with an odds ratio of 0.88 (95% CI: 0.44, 1.78), fair improvement with an odds ratio of 1.13 (95% CI: 0.56, 2.26) and side effects with an odds ratio of 0.82 (95% CI: 0.43, 1.56). The efficacy and safety of ablative laser were not higher than those of non-ablative laser in skin rejuvenation. Given the small samples of the included articles, it is recommended that further high-quality RCTs be conducted using larger samples to confirm this conclusion.
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Affiliation(s)
- Farnoosh Seirafianpour
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Pour Mohammad
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hojat Dehghanbanadaki
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Panahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Cytrellis: A Novel Microcoring Technology for Scarless Skin Removal: Summary of Three Prospective Clinical Trials. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3905. [PMID: 34729291 PMCID: PMC8556055 DOI: 10.1097/gox.0000000000003905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
Background We introduce an innovative and novel technology that achieves scarless skin removal without the use of thermal energy. Microcoring technology (MCT) uses a modified, hollow hypodermic needle to remove skin safely and without a scar. This method is advantageous compared to other fractional devices, given that it has the same benefits as energy-based devices (removal of skin cores without a scar), with the added value of immediate closure along the relaxed skin tension lines, with significantly less thermal energy. Methods Three prospective clinical safety trials analyzing MCT treatment on abdominal and facial skin (short- and long-term) are described. Results MCT treatment of human skin resulted in scarless skin removal that was well tolerated by patients. Healing occurred rapidly, with limited side effects. Skin area reduction (skin tightening) and increase in skin thickness were observed long term. Conclusions MCT treatment of human skin is safe and well tolerated. Although further studies on efficacy are required to evaluate the full potential of MCT in skin rejuvenation, early findings such as skin tightening and increase in skin thickness are encouraging.
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Heitmiller K, Ring C, Saedi N, Biesman B. Nonsurgical Light and Energy-Based Devices: Utility in Eyelid and Periorbital Surgery. Facial Plast Surg Clin North Am 2021; 29:323-334. [PMID: 33906764 DOI: 10.1016/j.fsc.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Periorbital rejuvenation is a common reason for patients to seek cosmetic treatment. There are several nonsurgical light and energy-based devices available to treat various aspects of periorbital rejuvenation without risks of an invasive, surgical procedure. Although ablative laser resurfacing appears to offer the most impressive clinical improvements, nonablative devices result in noticeable cosmetic improvement with more favorable side-effect profiles and shorter recovery times. The specific modality selected for periorbital rejuvenation should be tailored to patients' individual characteristics, preferences, and aesthetic goals. With continued advancements, additional nonsurgical light and energy-based devices will become available in the future for periorbital rejuvenation.
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Affiliation(s)
- Kerry Heitmiller
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina Ring
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nazanin Saedi
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Brian Biesman
- Ophthalmology, Dermatology, Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Özkoca D, Aşkın Ö, Engin B. Treatment of periorbital and perioral wrinkles with fractional Er:YAG laser: What are the effects of age, smoking, and Glogau stage? J Cosmet Dermatol 2021; 20:2800-2804. [PMID: 33550718 DOI: 10.1111/jocd.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/09/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dynamic and static wrinkling are observed on the facial skin as a result of aging. Previously, it was showed that fractional Er:YAG laser was effective in the treatment of facial wrinkles. AIMS The aims of this study are to determine the effects of age, Glogau stage, and smoking status on the treatment efficacy of fractional Er:YAG laser; and to compare the success of laser treatment on periorbital wrinkles with perioral wrinkles. MATERIAL/METHOD Periorbital and perioral wrinkles of the same patient were treated with fractional Er:YAG laser (2940 nm) for 4 sessions with monthly intervals. Treatment parameters were affluence of 1.5J, a spot size of 7 mm, and a frequency of 5 Hz. Treatment efficacy was evaluated by a blinded physician evaluation scale and patient satisfaction scale 2 months after the final treatment session. RESULTS Fifteen patients completed the study. The mean age of the patients was 42.8 years. The blinded physician evaluation of the improvement in the periorbital wrinkles decreased (P =.034) and the patient satisfaction in perioral wrinkles decreased (P =.049) with increasing age. The relationship between smoking and patient satisfaction in the treatment of periorbital wrinkles was also statistically significant (P =.014). No difference in terms of treatment efficacy was found between periorbital and perioral regions. CONCLUSION Fractional Er:YAG laser (2940 nm) is equally successful in the treatment of periorbital and perioral wrinkles. The treatment success decreases with smoking and increasing age.
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Affiliation(s)
- Defne Özkoca
- Cerrahpaşa Medical Faculty, Department of Dermatology and Venerology, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Özge Aşkın
- Cerrahpaşa Medical Faculty, Department of Dermatology and Venerology, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Burhan Engin
- Cerrahpaşa Medical Faculty, Department of Dermatology and Venerology, İstanbul University-Cerrahpaşa, İstanbul, Turkey
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8
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Bhargava S, Goldust M, Singer H, Negbenebor N, Kroumpouzos G. Evaluating resurfacing modalities in aesthetics. Clin Dermatol 2021; 40:274-282. [DOI: 10.1016/j.clindermatol.2021.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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9
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Efficacy, safety, and guidelines of application of the fractional ablative laser erbium YAG 2940 nm and non-ablative laser erbium glass in rejuvenation, skin spots, and acne in different skin phototypes: a systematic review. Lasers Med Sci 2020; 35:1877-1888. [PMID: 32472427 DOI: 10.1007/s10103-020-03046-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
Non-ablative and ablative fractional erbium lasers are among the most frequently used resources in dermatology for facial rejuvenation and for treating dermatological disorders. This type of erbium laser can be found at wavelengths of 1540 or 1550 nm, which are classified as non-ablative erbium glass, and at 2940 nm, classified as ablative erbium YAG. Despite the reports of their clinical benefits, few scientific studies have demonstrated the efficacy and safety of these lasers in the short or long term. In order to substantiate the effects, benefits, and safety of applying the erbium glass and erbium YAG lasers, a systematic review was carried out from August to December 2019 about studies published in the last 20 years. Randomized clinical trials in humans were considered that evaluated the efficacy, safety, and benefits of applying the fractional lasers erbium glass and erbium YAG to facial rejuvenation, skin spots, and atrophic acne scars. A total of 338 articles were identified; 76 articles remained after their titles and abstracts were read, and 42 articles were selected after removing the duplicates. After the articles were read in full, 17 of these articles were included in the systematic review (453 patients). The erbium glass and erbium YAG lasers seem promising in the short term, with minimal adverse effects; however, the long-term efficacy and safety still present limitations. Consequently, future research is needed, with better methodological standardization and a follow-up with a longer evaluation period for possible permanent adverse effects to determine the standardization and safety of therapy with erbium glass and erbium YAG lasers.
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Serdar ZA, Tatlıparmak A. Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: Six‐year experience with 333 patients. Dermatol Ther 2019; 32:e13054. [DOI: 10.1111/dth.13054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Zehra A. Serdar
- Department of DermatologyBahçeşehir University, Faculty of Medicine Istanbul Turkey
| | - Aslı Tatlıparmak
- Department of DermatologyBahçeşehir University, Faculty of Medicine Istanbul Turkey
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12
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Datz E, Schönberger C, Zeman F, Koller M, Berneburg M, Landthaler M, Karrer S, Hohenleutner U, Hohenleutner S. Fractional carbon dioxide laser resurfacing of skin grafts: long-term results of a prospective, randomized, split-scar, evaluator-blinded study. Lasers Surg Med 2018; 50:1010-1016. [DOI: 10.1002/lsm.22950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Elisabeth Datz
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Carmen Schönberger
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
- Operative Dentistry and Periodontology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Florian Zeman
- Centre for Clinical Studies; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Michael Koller
- Centre for Clinical Studies; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Michael Landthaler
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Ulrich Hohenleutner
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Silvia Hohenleutner
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
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Huang J, Yu W, Zhang Z, Chen X, Biskup E. Clinical and Histological Studies of Suborbital Wrinkles Treated with Fractional Bipolar Radiofrequency. Rejuvenation Res 2018; 21:117-122. [PMID: 28712336 DOI: 10.1089/rej.2017.1947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jun Huang
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Wenyou Yu
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Laser and Cosmetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Zhang
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Laser and Cosmetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangdong Chen
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ewelina Biskup
- Division of Internal Medicine,University Hospital of Basel, University of Basel, Basel, Switzerland
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14
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Chen KH, Tam KW, Chen IF, Huang SK, Tzeng PC, Wang HJ, Chen CC. A systematic review of comparative studies of CO 2 and erbium:YAG lasers in resurfacing facial rhytides (wrinkles). J COSMET LASER THER 2017; 19:199-204. [PMID: 28166434 DOI: 10.1080/14764172.2017.1288261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laser resurfacing is used to minimize wrinkles, solar scars and sequelae of acne. OBJECTIVE Purpose of the systematic review was to compare resurfacing outcomes of CO2 laser and erbium: yttrium aluminium garnet (erb:YAG) laser therapies. MATERIALS AND METHODS Medline, Cochrane Library, EMBASE and Google Scholar databases were searched until 9 April 2015 using the following terms: laser, carbon dioxide/CO2, facial wrinkles, rhytides and erbium-doped yttrium aluminium garnet/erbium:YAG/Er:YAG. Two-armed controlled split faced studies that compared CO2 laser and erbium:YAG laser in patients with mild-to-moderate facial wrinkles or rhytides were included. RESULTS The pooled data in this study and findings of other studies support the greater efficacy with the CO2 laser in improving facial wrinkles, but the erb:YAG laser was associated with a better complication profile compared with the CO2 laser. Except one case of hypopigmentation, other complications (i.e., erythema, hyperpigmentation and crusting) and their rates were reported by studies examining both lasers. CONCLUSION In general, the CO2 laser appeared to be more efficacious then the erb:YAG laser in treating facial wrinkles. Both lasers treatments were well tolerated.
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Affiliation(s)
- Kee-Hsin Chen
- a Department of Nursing , Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan.,b School of Nursing, College of Nursing , Taipei Medical University , Taipei , Taiwan.,c Graduate Institute of Clinical Medical Sciences, College of Medicine , Chang Gung University , Taoyuan City , Taiwan.,d Cochrane Taiwan , Taipei Medical University , Taipei , Taiwan.,e Evidence-Based Knowledge Translation Center, Wan Fang Medical Center , Taipei Medical University , Taipei , Taiwan
| | - Ka-Wai Tam
- d Cochrane Taiwan , Taipei Medical University , Taipei , Taiwan.,f Department of Surgery , Taipei Medical University - Shuang Ho Hospital , New Taipei City , Taiwan.,g Department of Surgery , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - I-Fan Chen
- h Graduate Institute of Management of Technology , National Chiao Tung University , Hsinchu , Taiwan
| | - Shihping Kevin Huang
- i Institute of Management of Technology , National Chiao Tung University , Hsinchu , Taiwan
| | - Pei-Chuan Tzeng
- j Department of Medical Education and Research , Wan Fang Medical Center, Taipei Medical University , Taipei , Taiwan
| | - Hsian-Jenn Wang
- k Division of Plastic Surgery, Department of Surgery , Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan.,l Department of Surgery , School of Medicine, College of Medicine, Taipei Medical University , Taiwan
| | - Chiehfeng Cliff Chen
- d Cochrane Taiwan , Taipei Medical University , Taipei , Taiwan.,k Division of Plastic Surgery, Department of Surgery , Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan.,l Department of Surgery , School of Medicine, College of Medicine, Taipei Medical University , Taiwan.,m Department of Public Health , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
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15
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Fractional Erbium-Doped Yttrium Aluminum Garnet Laser Versus Microneedling in Treatment of Atrophic Acne Scars: A Randomized Split-Face Clinical Study. Dermatol Surg 2017; 43 Suppl 1:S47-S56. [DOI: 10.1097/dss.0000000000000951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Robati RM, Asadi E. Efficacy and safety of fractional CO 2 laser versus fractional Er:YAG laser in the treatment of facial skin wrinkles. Lasers Med Sci 2016; 32:283-289. [PMID: 27885522 DOI: 10.1007/s10103-016-2111-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022]
Abstract
Ablative fractional lasers were introduced for treating facial rhytides. Few studies have compared fractional CO2 and Er:YAG lasers on cutaneous photodamages by a split trial. The aim of the present study was to compare these modalities in a randomized controlled double-blind split-face design with multiple sessions and larger sample size compared to previous studies done before. Forty patients with facial wrinkles were enrolled. Patients were randomly assigned to receive three monthly treatments on each side of the face, one with a fractional CO2 and one with a fractional Er:YAG laser. The evaluations included investigating clinical outcome determined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of cheeks using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT). Moreover, possible side effects and patients' satisfaction have been recorded at baseline, 1 month after each treatment, and 3 months after the last treatment session. Clinical assessment showed both modalities significantly reduce facial wrinkles (p value < 0.05), with no appreciable difference between two lasers. Mean CRRT values also decreased significantly after the laser treatment compared to the baseline in both laser groups. There was no serious long-standing adverse effect after both laser treatments, but the discomfort was more pronounced by the participants after CO2 laser treatment. According to the present study, both fractional CO2 and fractional Er:YAG lasers show considerable clinical improvement of facial skin wrinkles with no serious adverse effects, but post-treatment discomfort seems to be lower with Er:YAG laser.
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Affiliation(s)
- Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elmira Asadi
- Department of Dermatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lee SJ, Suh DH, Lee JM, Song KY, Ryu HJ. Dermal Remodeling of Burn Scar by Fractional CO2 Laser. Aesthetic Plast Surg 2016; 40:761-8. [PMID: 27519176 DOI: 10.1007/s00266-016-0686-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/29/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ablative CO2 fractional lasers have recently been introduced for burn scar treatment because of pronounced clinical outcomes with fewer treatment sessions than nonablative fractional laser. OBJECTIVE This study was conducted to observe clinical as well as histologic changes of burn scars after treatment with CO2 fractional laser. MATERIALS AND METHODS Eleven patients (one female and 10 males, aged 31-59 years) with skin phototypes III to V with burn scars received 10 sessions of fractional CO2 laser treatments (UltraPulse(®) Encore; Lumenis, Santa Clara, CA, USA) over an average 5-week interval. Two passes were performed using the following parameters: deep FX mode, 12.5-30 mJ, with a density setting of 5-10 %. Clinical evaluations by three blinded dermatologists were obtained at baseline and at 6 months after the final treatment via photographs using the Vancouver scar scale (VSS). Skin biopsies were done on four patients before and after treatment. RESULTS All patients showed clinical improvement in their scars with significant decrease in VSS. Histologic findings showed the changes in the upper dermis with newly formed dermal papilla. This characteristic upper dermis change was presented as improvement in surface smoothness and skin tension clinically. Postinflammatory hyperpigmentation and itching sensation were the most common adverse effects. CONCLUSION Burn scar treatment by fractional CO2 laser is effective by forming new collagen fibers mainly in the upper dermis. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sang-Jun Lee
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea
| | - Dong-Hye Suh
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea
| | - Ji Min Lee
- Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea
| | - Kye-Yong Song
- Department of Pathology, College of Medicine Chung-Ang University, Seoul, Korea
| | - Hwa Jung Ryu
- Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea.
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Abstract
Advances in laser technology in recent decades have increased the options for the treatment of dermatologic conditions of the eye and eyelid. Benign tumors can be laser-ablated with relative ease, and vascular and melanocytic lesions can be precisely targeted with modern lasers. In this contribution, we review treatment of periocular pigmented lesions, including melanocytic nevi and nevus of Ota; vascular lesions including telangiectasias, port wine stains, and infantile hemangiomas; hair removal; eyeliner tattoo removal; laser ablation of common benign periocular tumors, such as syringomas, xanthelasma, milia, and seborrheic keratoses; and laser resurfacing. The recent advent of fractionated laser technology has resulted in dramatically decreased healing times for periocular skin resurfacing and fewer adverse effects. Fractionated laser resurfacing has now nearly supplanted traditional full-field laser resurfacing, and safe treatment of rhytides on the thin skin of the eyelids is possible. Proper eye protection is, of course, essential when using lasers near the eye. Patient preparation, safety precautions, and risks--intraocular and extraocular--are discussed herein. As laser technology continues to advance, we are sure to see improvements in current treatments, as well as development of new applications of cutaneous lasers.
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Affiliation(s)
- Breton Yates
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut
| | - Syril Keena T Que
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut
| | - Logan D'Souza
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut
| | - Jeanine Suchecki
- Division of Ophthalmology, University of Connecticut Health Center, Department of Surgery, 263 Farmington Avenue, Farmington, Connecticut
| | - Justin J Finch
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut.
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Moon HR, Yun WJ, Lee YJ, Lee MW, Chang S. A prospective, randomized, double-blind comparison of an ablative fractional 2940-nm erbium-doped yttrium aluminum garnet laser with a nonablative fractional 1550-nm erbium-doped glass laser for the treatment of photoaged Asian skin. J DERMATOL TREAT 2015; 26:551-7. [DOI: 10.3109/09546634.2014.999020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Carniol PJ, Hamilton MM, Carniol ET. Current Status of Fractional Laser Resurfacing. JAMA FACIAL PLAST SU 2015; 17:360-6. [DOI: 10.1001/jamafacial.2015.0693] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul J. Carniol
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Summit
| | - Mark M. Hamilton
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Greenwood
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Abstract
In the setting of rapidly changing technology tone must make a decision on whether he or she places a premium on being an "early adopter" of technology or delay purchasing decisions until there is adequate proof that a particular technology is useful. Laser devices are a significant capital expenditure, and therefore members of the second group who base their purchasing decisions on evidence-based medicine may be able to avoid deploying capitol into a purchase that becomes obsolete as quickly as it appeared.
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Kohl E, Meierhöfer J, Koller M, Zeman F, Groesser L, Karrer S, Hohenleutner U, Landthaler M, Hohenleutner S. Fractional carbon dioxide laser resurfacing of rhytides and photoaged skin - A prospective clinical study on patient expectation and satisfaction. Lasers Surg Med 2015; 47:111-9. [DOI: 10.1002/lsm.22326] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Elisabeth Kohl
- Department of Dermatology; University Medical Center Regensburg; 93053 Regensburg Germany
| | - Julia Meierhöfer
- Department of Dermatology; University Medical Center Regensburg; 93053 Regensburg Germany
| | - Michael Koller
- Center for Clinical Studies; University Hospital Regensburg; 93053 Regensburg Germany
| | - Florian Zeman
- Center for Clinical Studies; University Hospital Regensburg; 93053 Regensburg Germany
| | - Leopold Groesser
- Department of Dermatology; University Medical Center Regensburg; 93053 Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology; University Medical Center Regensburg; 93053 Regensburg Germany
| | - Ulrich Hohenleutner
- Department of Dermatology; University Medical Center Regensburg; 93053 Regensburg Germany
| | - Michael Landthaler
- Department of Dermatology; University Medical Center Regensburg; 93053 Regensburg Germany
| | - Silvia Hohenleutner
- Department of Dermatology; University Medical Center Regensburg; 93053 Regensburg Germany
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Fractional CO2 Laser Is an Effective Therapeutic Modality for Xanthelasma Palpebrarum. Dermatol Surg 2014; 40:1349-55. [DOI: 10.1097/dss.0000000000000172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Kohl E, Meierhöfer J, Koller M, Zeman F, Klein A, Hohenleutner U, Landthaler M, Hohenleutner S. Fractional carbon dioxide laser resurfacing of rhytides and photoageing: a prospective study using profilometric analysis. Br J Dermatol 2014; 170:858-65. [DOI: 10.1111/bjd.12807] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2013] [Indexed: 11/27/2022]
Affiliation(s)
- E. Kohl
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - J. Meierhöfer
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - M. Koller
- Centre for Clinical Trials; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - F. Zeman
- Centre for Clinical Trials; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - A. Klein
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - U. Hohenleutner
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - M. Landthaler
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - S. Hohenleutner
- Department of Dermatology; University Hospital Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
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Sardana K, Manjhi M, Garg VK, Sagar V. Which type of atrophic acne scar (ice-pick, boxcar, or rolling) responds to nonablative fractional laser therapy? Dermatol Surg 2014; 40:288-300. [PMID: 24447255 DOI: 10.1111/dsu.12428] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have examined the role of fractional lasers in individual acne scars (ice-pick, box car, rolling) using objective assessment tools in darkly pigmented skin. OBJECTIVE To evaluate the effect of 1,540-nm fractional lasers on individual acne scars. METHODS AND MATERIALS A prospective interventional study was conducted in 35 patients using a 1,540-nm fractional laser. Six sessions were performed with four passes per session and a dose varying from 70 to 100 mJ to maximize the DWR. A self-devised objective assessment tool with dose settings to optimize the depth-to-width ratio (DWR) and a visual analog scale (VAS) were used to count individual atrophic scars. Final results were assessed 6 months after final laser treatment. RESULTS Acne scar reduction efficiency was used to validate the improvement of individual scars, a meaningful difference was considered as 51% or greater improvement. The boxcar scars (52.9%) responded better than the rolling (43.1%) and ice-pick scars (25.9%), with statistically significant improvement (p < .05) seen in boxcar scars after four sessions. Overall VAS scores revealed significant improvement (p < .001). CONCLUSION Using an objective evaluation tool, an erbium-doped glass laser was found to improve atrophic acne scars, markedly so for boxcar and rolling scars. The VAS score overestimated improvement because of its subjective nature.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology and Sexually Transmitted Diseases, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
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26
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Ko D, Kim K, Song K. A randomized trial comparing methyl aminolaevulinate photodynamic therapy with and without Er:YAG ablative fractional laser treatment in Asian patients with lower extremity Bowen disease: results from a 12-month follow-up. Br J Dermatol 2014; 170:165-72. [DOI: 10.1111/bjd.12627] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- D.Y. Ko
- Skin Cancer Center; Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong Seo-gu Busan 602-715 Korea
| | - K.H. Kim
- Skin Cancer Center; Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong Seo-gu Busan 602-715 Korea
| | - K.H. Song
- Skin Cancer Center; Department of Dermatology; College of Medicine; Dong-A University; Dong dae sin-dong Seo-gu Busan 602-715 Korea
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27
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Paasch U, Haedersdal M. Laser systems for ablative fractional resurfacing. Expert Rev Med Devices 2014; 8:67-83. [DOI: 10.1586/erd.10.74] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Yin R, Lin L, Xiao Y, Hao F, Hamblin MR. Combination ALA-PDT and ablative fractional Er:YAG laser (2,940 nm) on the treatment of severe acne. Lasers Surg Med 2014; 46:165-72. [PMID: 24391075 DOI: 10.1002/lsm.22219] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Scarring is a very common complication of severe acne and is difficult to treat by conventional methods. 5-Aminolevulinic acid (ALA) photodynamic therapy (PDT) is a novel treatment for improving acne lesions. Fractional laser resurfacing is a promising treatment for scar treatment because of its unique ability to stimulate the wound healing response and its depth of penetration. OBJECTIVE To evaluate the efficacy of combination therapies of ALA-PDT and ablative fractional Er:YAG laser (2,940 nm) for scarring lesions in severe acne patients. METHODS A prospective, single-arm, pilot study. Forty subjects with severe acne were treated with 15% ALA-PDT for four times at 10-day intervals. They then received ablative fractional Er:YAG laser treatment five times at 4-week intervals. Three independent investigators evaluated subject outcomes at 1, 3, 6, and 12 months post-treatment (primary outcome); patients also provided self-assessments of improvement (secondary outcome). RESULTS Significant reductions in acne score (P < 0.01) were obtained at follow-up visits after 1, 3, 6, and 12 months. After 6 month, the lesions showed overall improvement in all of subjects (good to excellent in acne inflammatory lesions), 80% overall improvement in acne scars. After 12 months, most of subjects had improved hypertrophic/atrophic scars (good to excellent in 85%) and no one had recurrent acne inflammatory lesions. Patient self-evaluation also revealed good to excellent improvements (on average) in acne lesions and scarring, with significant improvements in self-esteem after 6 months post-treatment. CONCLUSIONS PDT can control the inflammation and improve the severity of acne lesions. Fractional resurfacing is a promising new treatment modality for scars by stimulating wound healing and remodeling. The combination therapy is a promising option for severe acne to prevent and improve car formation.
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Affiliation(s)
- Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
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29
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Ko DY, Jeon SY, Kim KH, Song KH. Fractional erbium: YAG laser-assisted photodynamic therapy for facial actinic keratoses: a randomized, comparative, prospective study. J Eur Acad Dermatol Venereol 2013; 28:1529-39. [DOI: 10.1111/jdv.12334] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- D.-Y. Ko
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
| | - S.-Y. Jeon
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
| | - K.-H. Kim
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
| | - K.-H. Song
- Department of Dermatology; Skin Cancer Center; College of Medicine; Dong-A University; Busan Korea
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30
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Sebaratnam DF, Lim AC, Lowe PM, Goodman GJ, Bekhor P, Richards S. Lasers and laser-like devices: Part two. Australas J Dermatol 2013; 55:1-14. [DOI: 10.1111/ajd.12111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/11/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Deshan F Sebaratnam
- Department of Dermatology; Royal Prince Alfred Hospital; Camperdown New South Wales
- University of Sydney; Camperdown New South Wales
| | - Adrian C Lim
- Department of Dermatology; Royal North Shore Hospital; St Leonards New South Wales
| | - Patricia M Lowe
- Department of Dermatology; Royal Prince Alfred Hospital; Camperdown New South Wales
- University of Sydney; Camperdown New South Wales
| | | | - Philip Bekhor
- Department of Dermatology; Royal Childrens Hospital; Melbourne Victoria
| | - Shawn Richards
- Skin and Cancer Foundation Australia; Westmead New South Wales Australia
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31
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Affiliation(s)
- S Karsai
- Department of Dermatology, Klinikum Darmstadt, Heidelberger Landstr. 379, D-64297, Darmstadt, Germany; Department of Dermatology, University Hospital Greifswald, Greifswald, Germany.
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Visscher MO, Pan BS, Kitzmiller WJ. Photodamage: treatments and topicals for facial skin. Facial Plast Surg Clin North Am 2013; 21:61-75. [PMID: 23369590 DOI: 10.1016/j.fsc.2012.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article provides an overview of current therapies for photodamaged facial skin and their efficacy, with particular focus on studies that use the objective, quantitative evaluation methods discussed in the previous article. The role of topically applied agents including prescription drugs and cosmetics is discussed. From this information, a schema for the relative effectiveness of therapeutic modalities in reducing perceived age is presented. This information assists the facial plastic surgeon in evaluating patient expectations and selecting the most effective program.
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Affiliation(s)
- Marty O Visscher
- Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Preissig J, Hamilton K, Markus R. Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface. Semin Plast Surg 2013; 26:109-16. [PMID: 23904818 DOI: 10.1055/s-0032-1329413] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Numerous laser platforms exist that rejuvenate the skin by resurfacing its upper layers. In varying degrees, these lasers improve the appearance of lentigines and rhytides, eliminate photoaging, soften scarring due to acne and other causes, and treat dyspigmentation. Five major classes of dermatologic lasers are currently in common use: ablative and nonablative lasers in both fractionated and unfractionated forms as well as radiofrequency technologies. The gentler nonablative lasers allow for quicker healing, whereas harsher ablative lasers tend to be more effective. Fractionating either laser distributes the effect, increasing the number of treatments but minimizing downtime and complications. In this review article, the authors seek to inform surgeons about the current laser platforms available, clarify the differences between them, and thereby facilitate the identification of the most appropriate laser for their practice.
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Affiliation(s)
- Jason Preissig
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
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Choi JE, Oh GN, Kim JY, Seo SH, Ahn HH, Kye YC. Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers. J DERMATOL TREAT 2013; 25:299-303. [PMID: 23621348 DOI: 10.3109/09546634.2013.782090] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nonablative fractional photothermolysis has been reported to show early promise in the treatment of hypertrophic scars, but there are few reports on ablative fractional photothermolysis for the treatment of hypertrophic scars. AIM To evaluate and compare the efficacy and safety of Er:YAG fractional laser (EYFL) and CO2 fractional laser (CO2FL) for treatment of hypertrophic scars. METHODS Thirteen patients with hypertrophic scars were treated with 2,940 nm EYFL, and ten were treated with 10,600 nm CO2FL. An independent physician evaluator assessed the treatment outcomes using Vancouver scar scale (VSS) and 5-point grading scale (grade 0, no improvement; grade 1, 1-25%; grade 2, 26-50%; grade 3, 51-75%; grade 4, 76-100% improvement). Patients are queried about their subjective satisfaction with the treatment outcomes. RESULTS After the final treatment, average percentage changes of VSS were 28.2% for EYFL and 49.8% for CO2FL. Improvement was evident in terms of pliability, while insignificant in terms of vascularity and pigmentation. Based on physician's global assessment, mean grade of 1.8 for EYFL and 2.7 for CO2FL was achieved. Patient's subjective satisfaction scores paralleled the physician's objective evaluation. CONCLUSION CO2FL is a potentially effective and safe modality for the treatment of hypertrophic scars, particularly in terms of pliability.
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Affiliation(s)
- Jae Eun Choi
- Department of Dermatology, College of Medicine, Korea University , Seoul , Korea
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35
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Jung KE, Jung KH, Park YM, Lee JY, Kim TY, Kim HO, Kim HS. A Split-face comparison of ablative fractional lasers (CO2and Er:YAG) in Asian patients; postprocedure erythema, pain and patient's satisfaction. J COSMET LASER THER 2013; 15:70-3. [DOI: 10.3109/14764172.2012.759053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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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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Campolmi P, Bonan P, Cannarozzo G, Bruscino N, Moretti S. Efficacy and safety evaluation of an innovative CO2 laser/radiofrequency device in dermatology. J Eur Acad Dermatol Venereol 2012; 27:1481-90. [PMID: 23176105 DOI: 10.1111/jdv.12029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND CO2 laser has not only become the most widely used laser in dermatological surgical practice, but it has also proved to be highly effective in treating aesthetic imperfections. OBJECTIVE To examine the efficacy and safety of a novel fractional CO2 laser combined with a radiofrequency device in different dermatological, surgical and aesthetic fields. METHODS A total of 79 patients were treated in our Outpatient Service with a novel fractional CO2 laser combined with a bipolar radiofrequency device for a maximum of 5 months. Group A consisted of 39 patients with lesions requiring complete excision, whereas Group B consisted of 40 subjects seeking to enhance aesthetic facial imperfections. The results were assessed by three 'blind' investigators using photographs and clinical observations; in addition, the patients had to give their own subjective assessment of the results. RESULTS At the 6-month follow-up, the lesions of the Group A patients had been completely removed, except for one case of a large sebaceous nevus on the scalp. All the Group B patients showed global improvement in skin tightening, removal of fine lines and rhytides and correction of dilated pores and hyperpigmentation, with no significant side-effects and short downtimes. CONCLUSION This kind of laser meets the needs of the majority of dermatologists requiring a unique, versatile tool to remove cutaneous lesions and at the same time, safely and effectively treat skin imperfections.
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Affiliation(s)
- P Campolmi
- Department of Dermatology II, University of Florence, Florence, Italy
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39
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Tierney EP, Hanke CW. Fractionated carbon dioxide laser treatment of photoaging: prospective study in 45 patients and review of the literature. Dermatol Surg 2012; 37:1279-90. [PMID: 22988990 DOI: 10.1111/j.1524-4725.2011.02082.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ablative fractional photothermolysis (AFP) has been reported to be effective for photoaging. OBJECTIVE To perform a clinical trial in 45 patients with moderate to severe skin photoaging to quantify improvement with AFP. MATERIALS AND METHODS A prospective, single-blind study in 45 patients who presented for desired treatment of photoaging. Patients received a series of two to three treatments with AFP. RESULTS Thirty-nine women (86.7%) and six men (13.3%) were enrolled. Patients received two or three treatment sessions (mean 2.4). There were no incidence of adverse events of scarring, prolonged erythema (lasting more than 7 days), postinflammatory hyper- or hypopigmentation, or infection in the 108 treatment sessions given during this study. Mean improvement was 48.5% (95% confidence interval (CI)=44.6-52.4%) for skin texture, 50.3% (95% CI=46.1-54.5%) for skin laxity, 53.9% (95% CI=49.5-58.5%) for dyschromia, and 52.4% (95% CI=47.9-56.9%) for overall cosmetic outcome (all p<.05). CONCLUSIONS Significant improvement in photoaging of the face can be achieved using an AFP device with skin types I to III after a series of two to three treatments.
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Affiliation(s)
- Emily P Tierney
- Department of Dermatology, School of Medicine, Tufts University, Boston, Massachusetts, USA
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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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Khatri KA, Mahoney D, Hakam L. High-fluence fractional treatment of photodamaged facial skin using a 2940 nm erbium:yttrium-aluminum-garnet laser. J COSMET LASER THER 2012; 14:260-6. [DOI: 10.3109/14764172.2012.738911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee HM, Haw S, Kim JE, Won CH, Lee MW, Choi JH, Chang SE, Kim YJ, Goo BL. A fractional 2940 nm short-pulsed, erbium-doped yttrium aluminium garnet laser is effective and minimally invasive for the treatment of photodamaged skin in Asians. J COSMET LASER THER 2012; 14:253-9. [DOI: 10.3109/14764172.2012.738909] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Latowsky BC, Abbasi N, Dover JS, Arndt KA, Kaminer MS, Rohrer TE, Macgregor JL, Wesley NO, Durfee MA, Tahan SR. A randomized, controlled trial of four ablative fractionated lasers for photoaging: a quadrant study. Dermatol Surg 2012; 38:1477-89. [PMID: 22816441 DOI: 10.1111/j.1524-4725.2012.02500.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fractionated technology has revolutionized laser therapy. With the success of initial devices, several fractionated lasers have appeared on the market. Claims of superiority have made device choice difficult for physicians and patients. MATERIALS AND METHODS Twelve subjects were treated with fractionated ablative lasers (10,600-nm carbon dioxide and 2790-nm yttrium scandium gallium garnet) in this institutional review board-approved trial. Each face was divided into four quadrants, and each quadrant was randomly treated using one of four lasers. Clinical experience was used to optimize settings. Two patients submitted biopsies from each quadrant immediately after treatment. Patients and blinded investigators assessed pain during treatment and post-treatment improvement in photoaging (measured by rhytides, lentigines, texture, and pore size) using a five-point scale. RESULTS All devices resulted in statistical improvement in photoaging in all patients, but no device was statistically significantly superior. No statistically significant difference was found in pain scores. All patients reported satisfaction 1 month after treatment. Three patients experienced adverse reactions. Histologically, there were no statistically significant differences between devices. CONCLUSIONS Fractionated ablative lasers reliably result in improvement in photoaging. Despite marketing claims, no statistically significant differences were found in outcomes, pain during treatment, or histologic findings. Even with experienced users, significant adverse reactions are possible.
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Lee WR, Shen SC, Al-Suwayeh SA, Li YC, Fang JY. Erbium:YAG laser resurfacing increases skin permeability and the risk of excessive absorption of antibiotics and sunscreens: The influence of skin recovery on drug absorption. Toxicol Lett 2012; 211:150-8. [DOI: 10.1016/j.toxlet.2012.03.797] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 11/29/2022]
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Abstract
Based on the theory of stimulated emission of radiation that was proposed by Albert Einstein in 1916, the first lasers were developed in the 1960s. The first clinical use of laser technology in a German university took place in 1978 in the Department of Dermatology of the Ludwig-Maximilian-University in Munich under the guidance of the former director, Prof. Dr. med. Dr. h.c. mult. Otto Braun-Falco. In the following years, laser technology developed rapidly. Today laser technology is a widely used interdisciplinary therapeutic procedure that has deep clinical and scientific roots in dermatology. There are many conditions in both classic and aesthetic dermatology that are routinely - and sometimes exclusively - treated with lasers. Here we review recent developments in laser medicine. There seems to be a trend to combination procedures. To enhance efficacy, different laser systems are together or lasers are combined with specific topical medications.
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Affiliation(s)
- P Babilas
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
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Leyden J, Stephens TJ, Herndon JH. Multicenter clinical trial of a home-use nonablative fractional laser device for wrinkle reduction. J Am Acad Dermatol 2012; 67:975-84. [PMID: 22386051 DOI: 10.1016/j.jaad.2012.01.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 01/06/2012] [Accepted: 01/19/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Until now, nonablative fractional treatments could only be delivered in an office setting by trained professionals. OBJECTIVE The goal of this work was to perform clinical testing of a nonablative fractional laser device designed for home-use. METHODS This multicenter trial consisted of two clinical studies with slightly varying treatment protocols in which subjects performed at-home treatments of periorbital wrinkles using a handheld nonablative fractional laser. Both studies included an active treatment phase (daily treatments) and a maintenance phase (twice-weekly treatments). In all, 36 subjects were followed up for as long as 5 months after completion of the maintenance phase and 90 subjects were followed up until the completion of the maintenance phase. Evaluations included in-person investigator assessment, independent blinded review of high-resolution images using the Fitzpatrick Wrinkle Scale, and subject self-assessment. RESULTS All 124 subjects who completed the study were able to use the device following written instructions for use. Treatments were well tolerated with good protocol compliance. Independent blinded evaluations by a panel of physicians showed Fitzpatrick Wrinkle Scale score improvement by one or more grades in 90% of subjects at the completion of the active phase and in 79% of subjects at the completion of the maintenance phase. The most prevalent side effect was transient posttreatment erythema. LIMITATIONS Lack of a control group and single-blinded study groups were limitations. CONCLUSION Safety testing with self-applications by users demonstrated the utility of the device for home use. Independent blinded review of clinical images confirmed the device's proficiency for improving periorbital wrinkles.
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Affiliation(s)
- James Leyden
- Skin Study Center, Broomall, Pennsylvania 19008, USA.
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Munavalli GS, Turley A, Silapunt S, Biesman B. Combining confluent and fractionally ablative modalities of a novel 2790nm YSGG laser for facial resurfacing. Lasers Surg Med 2011; 43:273-82. [PMID: 21500221 DOI: 10.1002/lsm.21059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Girish S Munavalli
- Dermatology, Laser, and Vein Specialists of the Carolinas, Charlotte, North Carolina, USA
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Goldberg DJ, Hussain M. A study of multiple full-face treatments with low-energy settings of a 2940-nm Er:YAG fractionated laser. J COSMET LASER THER 2011; 13:42-6. [DOI: 10.3109/14764172.2011.564770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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