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Haykal D, Cartier H, Goldberg D, Gold M. Advancements in laser technologies for skin rejuvenation: A comprehensive review of efficacy and safety. J Cosmet Dermatol 2024. [PMID: 39158413 DOI: 10.1111/jocd.16514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Laser technology has fundamentally transformed the landscape of dermatology, offering nuanced solutions for skin rejuvenation and resurfacing. This paper aims to explore the spectrum of laser technologies, from ablative to non-ablative and fractional lasers, their mechanisms, benefits, and tailored applications for diverse skin conditions. As we delve into the intricacies of each technology, we also consider the scientific advancements that have made these treatments safer and more effective, promising a new horizon in skin rejuvenation. OBJECTIVE This comprehensive analysis seeks to evaluate recent advancements in laser technology for skin rejuvenation, focusing on efficacy, safety, and patient satisfaction. METHODS The selection criteria for studies in this publication focused on recent, peer-reviewed articles from the last 20 years, emphasizing advancements in laser technologies for skin rejuvenation. Our comprehensive review involved searches in PubMed, Cochrane, Scopus and Google Scholar using keywords like "skin rejuvenation," "laser technology," "efficacy," "safety," and "dermatology." This approach focused on inclusion of recent research and perspectives on the efficacy and safety of laser treatments in the field of dermatology. RESULTS Our literature review reveals advancements in laser skin resurfacing technologies, notably fractional lasers for minimal downtime rejuvenation, ablative lasers for precise tissue vaporization, and non-ablative lasers for coagulation effect promoting collagen with reduced recovery. Hybrid and picosecond lasers are highlighted for their versatility and effectiveness in addressing a wide array of skin concerns. The findings also emphasize the development of safer treatment protocols for ethnic skin, significantly reducing risks like hyperpigmentation and scarring, thus broadening the scope of effective dermatological solutions. CONCLUSION This extensive review of advancements in laser technologies for skin rejuvenation underscores a remarkable evolution in dermatological treatments, offering an expansive overview of the efficacy, safety, and patient satisfaction associated with these interventions. Furthermore, the exploration of combination treatments and laser-assisted drug delivery represents a frontier in dermatological practice, offering synergistic effects that could amplify the therapeutic benefits of laser treatments.
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Affiliation(s)
| | | | - David Goldberg
- Director of Cosmetic Dermatology and Clinical Research, Schweiger Dermatology Group, Clinical Professor of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Michael Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, Tennessee, USA
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Rutnin S, Yongpisarn T, Sakpuwadol N, Namasondhi A, Pomsoong C, Rattananukrom T, Thadanipon K. Efficacy and safety of 1064-nm fractional picosecond laser for the treatment of postmastectomy scars in transgender men: A randomized controlled trial. Lasers Surg Med 2024; 56:337-345. [PMID: 38436118 DOI: 10.1002/lsm.23775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Subcutaneous mastectomy is a crucial component of gender affirmation therapy for transgender men (TM), but the scars that result from this procedure can frequently impair their quality of life. This study aimed to assess the efficacy and safety of 1064-nm fractional picosecond laser (FxPico) treatment for hypertrophic and atrophic postmastectomy scars in TM. METHODS Twenty-two patients with a total of 35 pairs of bilateral symmetric mastectomy scars were enrolled. One of each pair of symmetric scars was randomly assigned to receive four FxPico treatments at 4-week intervals. All scars were evaluated using the modified Vancouver Scar Scale (mVSS) and three-dimensional imaging for scar roughness, melanin index, and hemoglobin index before each treatment session and at 1, 3, and 6 months following the last treatment. Additionally, participant-rated scar satisfaction (PSS) and scar improvement (Global Assessment Score, GAS), as well as adverse events were recorded. RESULTS During the 6-month follow-up period after the end of laser treatment sessions, the treated scars showed significant reductions in the mVSS compared to the untreated controls (p < 0.001), whereas the melanin index and hemoglobin index were not significantly different. Subgroup analysis of hypertrophic scars demonstrated statistically significant reductions in mVSS at 1 (p = 0.003) and 3 months (p = 0.041) after the end of laser treatments. PSS was significantly higher on the laser-treated scars than the controls (p = 0.008), and a participant-rated GAS of 2.95 ± 0.65 was found. There were no serious adverse events reported. CONCLUSIONS 1064-nm FxPico could be utilized to treat mastectomy scars among TM, particularly the hypertrophic type.
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Affiliation(s)
- Suthinee Rutnin
- Division of Dermatology, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | - Kunlawat Thadanipon
- Division of Dermatology, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Bangkok, Thailand
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Tawfik AA, Hanafy NS, Ali RA. Picosecond Nd:YAG versus Fractional CO 2 Lasers in Management of Postburn Scars. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5700. [PMID: 38525494 PMCID: PMC10959566 DOI: 10.1097/gox.0000000000005700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/31/2024] [Indexed: 03/26/2024]
Abstract
Background The picosecond laser was primarily designed to enhance tattoo removal. Because it has a new innovative mechanism for energy delivery, it has been modified to be used in other conditions such as skin resurfacing, which was usually treated with fractional CO2 laser. Comparing both technologies in managing postburn scars has not been widely addressed. Methods The current prospective comparative randomized intrapatient study was done on 15 patients who presented with unsightly postburn scarring. As a split study, one-half of the affected areas were treated using the picosecond Nd: YAG laser. The other areas were treated with a fractional CO2 laser. After three treatment sessions, the results were analyzed both objectively and subjectively. Results The assessment by the image analysis system (Antera camera) showed improvement in all the parameters in both groups. The melanin relative variation decreased from 11.65 ± 2.86, 15.85 ± 5.63 to 10.60 ± 1.96, 12.56 ± 3.98, respectively in picosecond laser sites and fractional CO2 sites. The percentage change in overall opinion decreased in in favor of the fractional CO2 laser sites, which is a statistically significant improvement. Instead, color scores revealed a greater reduction in the picosecond sites in comparison with the fractional CO2 sites, as it decreased from 7.67 ± 1.76, 7.73 ± 1.83 to 2.87 ± 1.06, 6 ± 1.2, respectively. Conclusions When compared with fractional CO2 lasers, picosecond Nd:YAG shows comparable improvements in scars' erythema, texture, and height, with some superiority in the management of hyperpigmented scars.
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Affiliation(s)
- Abeer Attia Tawfik
- From Dermatology and Laser, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
| | - Noha Sami Hanafy
- Research Department of Dermatology and Venereology, Medical Research Division, National Research Centre, Cairo, Egypt
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Liu X, Zeng R, Liu Y, Guo L, Zhang M, Zheng H, Wu Q, Ge Y, Lin T. Comparison of the 1064-nm picosecond laser with fractionated microlens array and 1565-nm non-ablative fractional laser for the treatment of enlarged pores: a randomized, split-face, controlled trial. Lasers Med Sci 2024; 39:80. [PMID: 38396012 DOI: 10.1007/s10103-024-04028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE This split-face randomized study compared the efficacy and safety between 1064-nm picosecond laser with fractionated microlens array (MLA) and 1565-nm nonablative fractional laser to treat enlarged pores. METHODS Participants with enlarged facial pores were enrolled and underwent three consecutive sessions at 2-week intervals with either a 1064-nm picosecond laser with MLA or a 1565-nm nonablative fractional laser. Images were captured at each visit. Objective (pore number) and subjective assessments, including patient self-evaluations and quartile improvement scales, were used to evaluate the treatment efficacy. The pain levels and adverse effects were recorded at each subsequent visit. RESULTS The participants were 3 men and 22 women with enlarged facial pores. At the initial and 2-month checkups after the last treatment, the pore numbers were significantly decreased bilaterally for both lasers. The respective quartile improvement scale scores for the 1064-nm picosecond and 1565-nm fractional lasers were 2.22 ± 1.06 and 2.14 ± 1.11, while those for patient self-assessment were 3.72 ± 0.74 and 3.68 ± 0.75. The pore number, quartile improvement scale score, and patients' self-assessments did not differ significantly between the two lasers. Treatment with the 1064-nm picosecond laser better reduced pain compared with the 1565-nm nonablative fractional laser (4.11 ± 1.33 vs. 4.83 ± 1.17). The occurrence of pigmentation did not differ significantly between the lasers. CONCLUSION Both the 1064-nm picosecond laser with MLA and the 1565-nm nonablative fractional laser are viable options for treating enlarged pores, and showed comparable respective efficacies; however, the former was less likely to cause hyperpigmentation and was better tolerated.
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Affiliation(s)
- Xing Liu
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China
| | - Rong Zeng
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China.
- Department of Dermatology, Yunnan Provincial Hospital of Traditional Chinese Medicine, 650021, No. 120 Guanghua Rd, Kunming, 650021, China.
| | - Yuzhen Liu
- Department of dermatology, Nanjing Jiangning Hospital, Nanjing, 211100, China
| | - Lifang Guo
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China
| | - Mengli Zhang
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China
| | - Huiying Zheng
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China
| | - Qiuju Wu
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China
| | - Yiping Ge
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China
| | - Tong Lin
- Department of laser surgery, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangwangmiao Street 12, Xuanwu District, Nanjing, 210042, China.
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Harnchoowong S, Vachiramon V, Jurairattanaporn N. Cosmetic Considerations in Dark-Skinned Patients. Clin Cosmet Investig Dermatol 2024; 17:259-277. [PMID: 38321987 PMCID: PMC10844008 DOI: 10.2147/ccid.s450081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
For dermatologists, diversities of human races result in an opportunity to encounter patients with various skin types. Cosmetic procedures have gained more popularity and become more accessible over the past decades. Thus, the selection of appropriate treatment protocol for each patient becomes inevitable. This review will focus on basic knowledge and key points in performing safe cosmetic-related procedures in patients with dark-complexioned skin. In terms of structure and function of the skin, people of color have equal epidermal thickness, corneocyte size and melanocyte number. However, they have more stratum corneum compaction, melanosome dispersion and melanocyte activity than fair skin individuals. Data regarding drug penetration and cutaneous irritation showed conflicting results. Superficial chemical peels and microdermabrasion can be done safely in dark-skinned patients. Medium-depth peel should be used with extreme caution. While deep-depth peel should be avoided at all times due to pigmentary and textural complications. Prolonged treatment interval, use of priming agents and sun protection are recommended. Injectable materials including botulinum toxin and soft tissue augmentation by hyaluronic acid filler can be done harmlessly in dark-skinned patients. Lasers and energy-based devices should be done with caution. Higher melanin dispersion and melanocyte activity acts as competitive chromophore. Pigmentary or textural changes can occur after aggressive treatment protocol. High energy setting, pulse stacking, short wavelength lasers and short treatment interval should be avoided in dark-skinned patients.
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Affiliation(s)
- Sarawin Harnchoowong
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthachat Jurairattanaporn
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Lee SH, Kim DH, Jo SJ, Lim Y, Lee JW, Lee JH, Kim TM, Kim SR, Kang J, Yoon JY, Suh DH. The efficacy and safety of low- versus high-fluence fractional picosecond Nd:YAG 1064-nm laser in the treatment of acne scars: A randomized split-face comparison study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12922. [PMID: 37898983 DOI: 10.1111/phpp.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Differences in clinical efficacy based on the fluence of fractional picosecond laser treatment for acne scars are unknown. OBJECTIVE To compare the efficacy and safety of low-fluence versus high-fluence fractional picosecond Nd:YAG 1064-nm laser treatment in acne scar patients. METHODS In this 12-week, investigator-blinded, randomized, split-face study, 25 patients with moderate-to-severe acne scars received three sessions of high-fluence laser treatment (1.0 J/cm2 ) on one side of their face and low-fluence (0.3 J/cm2 ) on the other side every 4 weeks. Patients were assessed using acne scar counts, the scar global assessment (SGA), and the ECCA scar grading scale every 4 weeks. The histological analysis compared the acne scars obtained before and 4 weeks after treatment. RESULTS At their last visit, 88.00% and 92.00% of the subjects achieved >30% reduction in scar counts on the low- and high-fluence sides, respectively, without a significant difference between the two sides. On both sides, the scar counts, SGA, and ECCA score significantly improved 4 weeks after the last treatment. Although the high-fluence side showed a greater reduction in scar counts (-66.73%) than the low-fluence side (-62.13%), the two sides had no significant difference in the grading scores. The high-fluence side showed significantly more severe pain and higher side-effect scores immediately and 4 weeks after treatment. Histological analysis revealed a significantly increased collagen, elastin, and vimentin expression after treatment on the low-fluence side. CONCLUSIONS The low-fluence setting demonstrated comparable efficacy and superior safety in treating acne scars compared with the high-fluence setting.
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Affiliation(s)
- Si-Hyung Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyo Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Acne, Rosacea, Seborrheic Dermatitis and Hidradenitis Suppurativa Research Laboratory, Seoul National University Hospital, Seoul, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Youngkyoung Lim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Hyo Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Acne, Rosacea, Seborrheic Dermatitis and Hidradenitis Suppurativa Research Laboratory, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeewoo Kang
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Young Yoon
- Acne, Rosacea, Seborrheic Dermatitis and Hidradenitis Suppurativa Research Laboratory, Seoul National University Hospital, Seoul, Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Acne, Rosacea, Seborrheic Dermatitis and Hidradenitis Suppurativa Research Laboratory, Seoul National University Hospital, Seoul, Korea
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Dai R, Cao Y, Su Y, Cai S. Comparison of 1064-nm Nd:YAG picosecond laser using fractional micro-lens array vs. ablative fractional 2940-nm Er:YAG laser for the treatment of atrophic acne scar in Asians: a 20-week prospective, randomized, split-face, controlled pilot study. Front Med (Lausanne) 2023; 10:1248831. [PMID: 38034535 PMCID: PMC10687437 DOI: 10.3389/fmed.2023.1248831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background The 1064-nm Nd:YAG picosecond lasers using fractional micro-lens array (P-MLA) was a promising therapy for skin resurfacing. However, no studies have compared P-MLA with ablative fractional 2940-nm Er:YAG lasers (AF-Er) in the treatment of atrophic acne scars. Objectives To evaluate the efficacy and safety of P-MLA and AF-Er for the treatment of atrophic acne scars. Methods We performed a prospective, randomized, split-face, controlled pilot study. Thirty-one Asian patients with mild to moderate atrophic acne scars underwent four consecutive sessions of randomized split-face treatment with P-MLA and AF-Fr at 4-week intervals. The efficacy of the two devices were evaluated by Echelle d'Evaluation Clinique des Cicatrices d'acne (ECCA) grading scale, Investigator's Global Assessment (IGA) score and patient's satisfaction. VISIA analysis was also performed to evaluate the pore and skin texture. Adverse events were recorded at each follow-up. Results The P-MLA afforded comparable clinical responses in scar appearance as AF-Er based on the investigator's assessments (ECCA percent reduction: 39.11% vs. 43.73%; IGA score: 2.97 ± 0.65 vs. 3.16 ± 0.68; P > 0.05 for both). However, the result of patient satisfaction indicated the AF-Er-treated side achieved a slightly greater improvement in scar appearance (3.97 ± 0.78 vs. 3.55 ± 0.71; P < 0.05). Overall, the two devices did not differ largely in terms of efficacy. VISIA analysis revealed similar changing patterns of the pore and skin texture between two devices. For safety profiles, no serious side effects were reported on both sides. The P-MLA showed lower pain level, shortened duration of crust shed and edema, and less occurrence of PIH (P < 0.05 for all). Conclusion Compared with AF-Er, P-MLA afforded comparable effect and more safety profiles in treating atrophic acne scars in Asian patients. Clinical trial registration ClinicalTrials.gov, identifier NCT05686603.
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Affiliation(s)
- Ru Dai
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yiyu Cao
- Research Department of Industrial Development, Zhejiang Development & Planning Institute, Hangzhou, China
| | - Yiping Su
- Department of Dermatology, The First People Hospital of Hangzhou Linan District, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Suiqing Cai
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Disphanurat W, Charutanan N, Sitthiwatthanawong P, Suthiwartnarueput W. Efficacy and safety of fractional 1064-nm picosecond laser for atrophic traumatic and surgical scars: A randomized, single-blinded, split-scar-controlled study. Lasers Surg Med 2023. [PMID: 37130437 DOI: 10.1002/lsm.23675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/05/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE A fractional 1064-nm picosecond laser is an efficient and safe treatment for atrophic acne scars. However, evidence of using a picosecond laser for atrophic posttraumatic and surgical scar therapy is lacking. This study aimed to evaluate the efficacy and safety of using a 1064-nm picosecond laser with a microlens array (MLA) for the treatment of atrophic posttraumatic and surgical scars. METHODS This was a prospective, intraindividual, single-blinded, randomized split-lesion-controlled trial. Twenty-five subjects with atrophic traumatic or surgical scars that existed for more than 1 year were enrolled. All atrophic scars were divided at the midline into two halves and randomly assigned to a treatment or control side. The treatment group was treated with a 1064-nm picosecond laser with an MLA handpiece (spot size: 6-8 mm, fluence: 1.0-1.2 J/cm2 , repetition rate: 5 Hz, three passes) for 3 monthly sessions. The scar volumes were objectively measured using a three-dimensional (3D) photograph at baseline, 1 month after the first and second treatments, and 3 and 6 months after the final treatment. Subjective assessments were conducted by a blinded dermatologist and patients' self-assessment to evaluate improvements at 3 months after the final treatment. RESULTS The treated sides exhibited a significant volume reduction, with statistically significant improvements over the control group at 1 month after the first and second treatments and at 3 months after the final treatment (p = 0.024, 0.005, and 0.019, respectively). At 3 months after the final treatment, a blinded dermatologist correctly identified the treated side in 24 of 25 patients (96%). The patients rated the improvements as excellent (>75%) and marked (50%-75%) in 36% and 48% of patients, respectively. CONCLUSION At 3 months, the 1064-nm picosecond laser with a fractionated MLA can significantly reduce the posttraumatic and postsurgical atrophic scar volume in patients with Fitzpatrick skin types III-V. Insufficient data preclude inferences regarding efficacy at 6 months.
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Affiliation(s)
- Wareeporn Disphanurat
- Department of Medicine, Division of Dermatology, Thammasat University, Pathum Thani, Thailand
| | - Nipathorn Charutanan
- Department of Medicine, Division of Dermatology, Thammasat University, Pathum Thani, Thailand
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Teymour S, Kania B, Lal K, Goldberg D. Energy-based devices in the treatment of acne scars in skin of color. J Cosmet Dermatol 2023; 22:1177-1184. [PMID: 36575886 DOI: 10.1111/jocd.15572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acne scarring is disfiguring and psychologically taxing on patients. Many energy-based modalities have emerged and been studied for the treatment of acne scarring; however, there is a paucity of these studies in skin phototypes IV-VI. OBJECTIVE To review the medical literature and discuss the most significant studies regarding safety and efficacy of energy-based devices (ablative lasers, non-ablative lasers, and radiofrequency microneedling) in the treatment of ethnic skin (skin phototypes IV-VI). METHODS A literature search was conducted using the PubMed database and bibliographies of relevant articles. RESULTS Ablative and non-ablative lasers have proven to be effective for treatment of acne scars in ethnic skin. The risk of developing adverse effects such as post-inflammatory hyperpigmentation is contingent upon several factors including skin phototype, laser device, fluence, and moreso density settings. Non-ablative fractional lasers have been considered first line for the treatment of acne scars in skin of color due to their better safety profile; however, they are less efficacious and require more treatments compared to ablative lasers. Studies regarding efficacy and safety of radiofrequency microneedling for treatment of acne scarring in skin of color are limited, but are promising. CONCLUSION Ablative lasers, non-ablative lasers, and radiofrequency microneedling are all useful treatments for acne scarring in ethnic skin when appropriate settings are used. Further head-to-head studies are needed to evaluate their efficacy and safety in darker skin phototypes V-VI.
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Affiliation(s)
- Shereen Teymour
- Department of Dermatology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Barbara Kania
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, New Jersey, USA
| | - Karan Lal
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, New Jersey, USA
| | - David Goldberg
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, New Jersey, USA
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Xue H, Ye D, Huang S, He S, Li Y, Liu J, Hu D, Zhu Y, Hu G, Dong Y, Shen H, Zeng WH, Wang Z. Efficacy and safety of low-dose oral isotretinoin monotherapy versus combined therapy with picosecond laser for the treatment of acne scars in Asian population. Lasers Surg Med 2023; 55:359-371. [PMID: 36856028 DOI: 10.1002/lsm.23646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/12/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Acne scars are common in patients with moderate to severe acne. Isotretinoin is the first-line treatment for those patients, but whether oral isotretinoin can improve acne scar is not clear. Picosecond lasers (FxPico) has been reported to improve acne scars. In the present study, we evaluated the clinical efficacy of low-dose isotretinoin with or without FxPico treatment for acne scars. MATERIALS AND METHODS A total of 48 patients with acne scars were enrolled and were randomly assigned to receive low dose oral isotretinoin or not. For all the patients in both treatment groups, one side of face were randomly assigned to be treated with picosecond laser. Assessments, including photos, échelle d'évaluation clinique des cicatrices d'acné (ECCA) and Global Acne Grading System (GAGS) score, the number of lesions, melanin and erythema indexes, transepidermal water loss were assessed at 0, 1, 2, and 3 month. Side effects, Dermatology Life Quality Index (DLQI) and satisfaction were recorded before and after the study. RESULTS A total of 44 patients completed the study (24 received oral low dose isotretinoin and 20 did not). Low dose oral isotretinoin treated group showed significant improvement on ECCA (from 112.5 [50-180] to 105 [50-160]), GAGS score (from 12.6 ± 3.3 to 10.1 ± 3.0), the count of papules (from 4.3 ± 3.7 to 1.0 ± 1.5) than the blank group, and higher improvement were noticed after isotretinoin combined with FxPico. All the side effects were temporary and tolerable, no adverse effects were observed. Higher DLQI and patients' satisfaction were achieved by oral isotretinoin alone and isotretinoin combined with FxPico. CONCLUSIONS This is the first paper showing the improvement of scars by early low dose-isotretinoin intervention with or without the combination of picosecond laser. Early intervention with oral low-dose isotretinoin is effective for the treatment and prevention of acne scars, the combined therapy with FxPico can achieve better outcome.
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Affiliation(s)
- Huan Xue
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dan Ye
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shiliu Huang
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shujuan He
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Youbao Li
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Liu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Die Hu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yu Zhu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guanglei Hu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yan Dong
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Editorial Department of Chinese Journal of Dermatovenereology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hua Shen
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Xi'an Asia-Pacific Medical Beauty Hospital, Xi'an, Shaanxi, China
| | - Wei-Hui Zeng
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhao Wang
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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11
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Zhou Y, Hamblin MR, Wen X. An update on fractional picosecond laser treatment: histology and clinical applications. Lasers Med Sci 2023; 38:45. [PMID: 36658259 PMCID: PMC9852188 DOI: 10.1007/s10103-022-03704-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023]
Abstract
Picosecond lasers have a very short pulse duration and a high peak power density. When fractional optical delivery systems are attached to picosecond lasers, they generate an array of concentrated microspots with a high fluence surrounded by areas with a low fluence. This article discusses the histologic characteristics and clinical applications of fractional picosecond laser treatment. Fractional picosecond laser produces laser-induced optical breakdown (LIOB) and laser-induced cavitation (LIC) in the epidermis and dermis respectively, and can encourage skin regeneration and dermal remodeling. It has been shown that fractional picosecond laser has a positive effect on facial photoaging, enlarged facial pores, dyspigmentation, wrinkles, and atrophic scars. Further research is still needed to confirm the benefits of fractional picosecond lasers.
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Affiliation(s)
- Yanjun Zhou
- Department of Dermatology, West China Hospital, Sichuan University, No.37 Guoxue Road, Chengdu, 610041, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, No.37 Guoxue Road, Chengdu, 610041, China.
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China.
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12
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Xue H, Ye D, Huang SL, He SJ, Liu J, Mu SZ, Li YB, Hu GL, Hu D, Wang Z, Zeng WH. Early acne scar intervention with 1064 nm picosecond laser in patients receiving oral isotretinoin: a randomized split-face controlled pilot study. Lasers Med Sci 2023; 38:40. [PMID: 36633795 DOI: 10.1007/s10103-022-03702-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
Early acne scar intervention is important. Oral isotretinoin is widely used in patients with moderate to severe acne. Picosecond laser has shown a promising effect on scar clearance. However, there is a lack of reports on the efficacy and safety of early acne scar management by using 1064-nm picosecond laser in patients receiving low-dose oral isotretinoin. Twenty-four patients with atrophic acne scars of Fitzpatrick skin type III to V were enrolled. All patients were receiving low-dose oral isotretinoin (0.12-0.22 mg/kg/day) during the treatment. The face of the participants was randomly assigned to receive 2 sessions of fractional picosecond 1064 nm Nd: YAG laser (FxPico) treatment and 2 follow-ups, with an interval of 1 month (month 0-3). Clinical efficacy and safety were assessed by photographs, ECCA grading scale, the number of scar lesions melanin and erythema indexes (MI and EI), TEWL, DLQI, and patient satisfaction and the adverse events were recorded on every visit. FxPico significantly decreased the ECCA score and showed higher improvement in the ECCA score. FxPico treated side achieved a significant reduction in all acne scar types, while only boxcar scars and rolling scars showed higher improvement. TEWL but not MI or EI were significantly improved. DLQI and patient satisfaction were higher with the FxPico-treated side than control side. No adverse effects were observed and all the side effects observed were temporary and tolerable. Early intervention by FxPico on patients receiving low-dose oral isotretinoin is a safe and effective modality to improve atrophic acne scars.
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Affiliation(s)
- Huan Xue
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Dan Ye
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Shi-Liu Huang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Shu-Juan He
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Jing Liu
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Sheng-Zhi Mu
- Department of Burn and Plastic Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - You-Bao Li
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Guang-Lei Hu
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Die Hu
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Zhao Wang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China.
| | - Wei-Hui Zeng
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China.
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13
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Chen SX, Cheng J, Watchmaker J, Dover JS, Chung HJ. Review of Lasers and Energy-Based Devices for Skin Rejuvenation and Scar Treatment With Histologic Correlations. Dermatol Surg 2022; 48:441-448. [PMID: 35165220 DOI: 10.1097/dss.0000000000003397] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lasers and energy-based devices (EBD) are popular treatments for skin rejuvenation and resurfacing. Achieving desired outcomes and avoiding complications require understanding the effects of these devices at a histologic level. Currently, no comprehensive review summarizing the histologic effects of laser and energy-based treatments exists. OBJECTIVE To describe how lasers and EBD alter skin histology and improve the overall understanding of these devices. MATERIALS AND METHODS A PubMed search was conducted for studies with histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative lasers, and ablative lasers. RESULTS Fractional picosecond lasers induce intraepidermal and/or dermal vacuoles from laser-induced optical breakdown. Fractional radiofrequency microneedling delivers thermal energy to the dermis while sparing the epidermis, making it safer for patients with darker skin phototypes. Fractional nonablative lasers induce conical zones of coagulation of the epidermis and upper dermis. Ablative lasers vaporize the stratum corneum down to the dermis. Traditional ablative lasers cause diffuse vaporization while fractional ablative lasers generate columns of tissue ablation. CONCLUSION Lasers and EBD are effective for skin resurfacing and rejuvenation and have different mechanisms with disparate targets in the skin. Safe and effective use of devices requires understanding the histologic laser-tissue interaction.
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Affiliation(s)
- Stella X Chen
- Harvard Combined Dermatology Residency Program, Boston, Massachusetts
| | - Judy Cheng
- Department of Dermatology, Northwestern Medical Group, Chicago, Illinois
| | | | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Hye Jin Chung
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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14
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Mani N, Zorman A. Acne scar treatment using high-energy fractional nanosecond Q-switched 1064 nm laser. J Cosmet Dermatol 2021; 20:3907-3912. [PMID: 34648683 PMCID: PMC9291920 DOI: 10.1111/jocd.14534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 01/05/2023]
Abstract
Aims The objective of this study was to evaluate the effectiveness and safety of high‐energy ablative fractional nanosecond Q‐switched 1064 nm laser therapy for acne scars. Material and methods Forty‐six patients aged from 16 to 69 years and of Fitzpatrick skin type from 2 to 4 were included in this retrospective study. Multiple passes were delivered with a fractional 1064‐nm handpiece at high energy. Results were evaluated using blinded analysis of patient before and after photographs and also by evaluating patient satisfaction. Results Most patients (75%) were improved or very improved according to blinded evaluation. Patient satisfaction was high. No hypo/hyperpigmentation, scarring, or any other side effects were reported by any of the patients. Conclusions The study demonstrated good clinical outcomes in facial acne scar management with a high patient satisfaction rate and no adverse side effects.
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Affiliation(s)
- Nasrin Mani
- La Jolla Cosmetic Laser Clinic, La Jolla, CA, USA
| | - Anže Zorman
- Medilase Ljubljana Slovenia, Ljubljana, Slovenia
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15
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Shi Y, Jiang W, Li W, Zhang W, Zou Y. Comparison of fractionated frequency-doubled 1,064/532 nm picosecond Nd:YAG lasers and non-ablative fractional 1,540 nm Er: glass in the treatment of facial atrophic scars: a randomized, split-face, double-blind trial. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:862. [PMID: 34164496 PMCID: PMC8184496 DOI: 10.21037/atm-21-1715] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Laser treatment of acne scars is common, but quality evidence on its efficacy is still needed. Our study aimed to compare picosecond laser and non-ablative fractional laser’s efficacy and safety in treating acne atrophic scars. Methods This was a randomized, split-face double-blind trial recruiting patients with acne atrophic scars. Facial halves were randomly divided and treated with fractionated frequency-doubled 1,064/532 nm picosecond Nd:YAG laser or non-ablative fractional 1,540 nm Er: glass laser. ECCA score (echelle d'evaluation clinique des cicatrices d’acne) and skin flatness measured with a non-invasive phaseshift rapid in vivo measurement of skin (PRIMOS) system were evaluated one month after the last treatment. Results Twenty-two Fitzpatrick skin type IV patients were included in this study, with an average age of 29.68 years, an average duration of acne scars of 8.8 years. Picosecond laser impacted all acne scar types (before and after treatment; P=0.000 for all types, P<0.001 for V-type, P=0.002 for U-type, and P=0.021 for M-type) and more pronounced effect on ECCA score than non-ablative laser for V-type and U-type acne scars. After treatment, each treatment site’s height was significantly lower than that before treatment (P=0.041) in the picosecond group but not in the non-ablative group (P=0.785). The reported erythema rate was higher in patients treated with a picosecond laser, while edema, exudation, purpura, pain, and long-term AEs were similar between the groups. Conclusions Fractionated frequency-doubled 1,064/532 nm Picosecond Nd: YAG laser showed better efficacy in treating acne atrophic scars than the alternative and provided satisfactory safety with added improvement in pores and the glossiness of the skin. Registration number ChiCTR2100045982 (comparison of fractionated frequency-doubled 1,064/532 nm picosecond Nd: YAG lasers and nonablative fractional 1,540 nm Er: glass in the treatment of facial atrophic scar: a randomized, split-face, double-blind controlled trial).
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Affiliation(s)
- Yu Shi
- Department of Medical Cosmetology, Tongji University Affiliated Shanghai Skin Disease Hospital, Shanghai, China
| | - Wencai Jiang
- Department of Skin, and Cosmetic Research Department, Tongji University Affiliated Shanghai Skin Disease Hospital, Shanghai, China
| | - Wei Li
- Department of Medical Cosmetology, Tongji University Affiliated Shanghai Skin Disease Hospital, Shanghai, China
| | - Wei Zhang
- Department of Medical Cosmetology, Tongji University Affiliated Shanghai Skin Disease Hospital, Shanghai, China
| | - Ying Zou
- Department of Medical Cosmetology, Tongji University Affiliated Shanghai Skin Disease Hospital, Shanghai, China
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16
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Sathaworawong A, Manuskiatti W, Phatihattakorn C, Ungaksornpairote C, Ng JN. The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser in the treatment of decreased sexual sensation: a randomized, placebo-controlled trial. Lasers Med Sci 2021; 37:581-588. [PMID: 33791888 DOI: 10.1007/s10103-021-03305-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
Vaginal laxity, a common cause of decreased sexual sensation, is a common problem affecting the quality of life of women worldwide. Recently, lasers and energy-based devices (EBDs) have been applied in the treatment of this condition. The aim of this study was to compare the efficacy and safety of Er:YAG laser and placebo in treating decreased sexual sensation in Asians. Forty-two patients with decreased sexual sensation were randomized into 2 groups: intervention (laser treatment) and control (placebo treatment). Both groups received two treatments, at 1-month interval. Subjective and objective evaluations were done at baseline, 1-, 3-, and 6-month follow-ups. Pain score and adverse effects were also recorded. In the laser group, there was significant improvement in the patients' vaginal tightness satisfaction at 1- and 3-month follow-ups (P = 0.002 and 0.004) and also in the patients' overall satisfaction at 1- and 3-month follow-ups (P = 0.003 and 0.001). Pelvic floor muscle contraction was significantly better in the laser group after the first treatment (P = 0.043). No serious adverse effects were noted. Er:YAG laser provides improvement of sexual sensation for an average of 3 months following treatment. Mild and transient adverse effects such as leukorrhea, dryness, dysuria, vaginal itching, and spot bleeding were noted in the laser group, and these were not significantly different from the control group.
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Affiliation(s)
- Angkana Sathaworawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand.
| | - Chayawat Phatihattakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanida Ungaksornpairote
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
| | - Janice Natasha Ng
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, 10700, Thailand
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