Review of nonablative laser resurfacing modalities

A new multi-modal fractional ablative CO2 laser for wrinkle reduction and skin resurfacing

BACKGROUND

The concept of fractional delivery modality of the energy with both ablative and non-ablative devices is now well known and accepted as an effective method to attain significant aesthetic improvements on facial aging skin. A new, multi-modal, fractional, ablative CO2 laser that can create, using same scanner/handpiece, deep columns in addition to superficial ablation has been recently proposed and therefore investigated.

METHOD

Twenty-four patients were enrolled in this evaluation. Each of them received one multi-modal, fractional ablative treatment. Patients were clinically and photographically evaluated at baseline and 6 months after the procedure. The degree of photoaging and the efficacy of treatment were evaluated using a VAS five-point scale of some skin features. A 3D images comparison was furthermore performed to objectify the improvements.

RESULTS

For all of the analysed skin features of photodamage a significant, statistical improvement was obtained. The data collected with the 3D system demonstrated an average improvement of 42% of the wrinkles and an average improvement of the melanin variation of 40.1%.

CONCLUSIONS

The multi-modal approach with a single handpiece allows obtaining good outcomes with a very low incidence of adverse effects and a short downtime.

Random fractional ultrapulsed CO2 resurfacing of photodamaged facial skin: long-term evaluation

Although numerous papers have recently been published on ablative fractional resurfacing, there is a lack of information in literature on very long-term results. The aim of this retrospective study is to evaluate the efficacy, adverse side effects, and long-term results of a random fractional ultrapulsed CO2 laser on a large population with photodamaged facial skin. Three hundred twelve patients with facial photodamaged skin were enrolled and underwent a single full-face treatment. Six aspects of photodamaged skin were recorded using a 5 point scale at 3, 6, and 24 months after the treatment. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Three hundred one patients completed the study. All analyzed features showed a significant statistical improvement 3 months after the procedure. Three months later all features, except for pigmentations, once again showed a significant statistical improvement. Results after 24 months were similar to those assessed 18 months before. No long-term or other serious complications were observed. From the significant number of patients analyzed, long-term results demonstrate not only how fractional ultrapulsed CO2 resurfacing can achieve good results on photodamaged facial skin but also how these results can be considered stable 2 years after the procedure.

Exploring the role of a nonablative laser (1320 nm cooltouch laser) in skin photorejuvenation

BACKGROUND

Nonablative laser has been used for the treatment and prevention of skin aging for many years. Although the mechanism has not been elucidated, histological evaluation showed that the dermal fibroblasts and its collagen production should be the main target for this rejuvenation. In order to determine the effects of a 1320 nm nonablative laser on the human dermal fibroblasts, the two main secretion factors, basic fibroblast growth factor (bFGF) and transforming growth factor β1(TGF-β1), in vitro were detected.

METHODS

The human dermal fibroblasts were cultured and irradiated with a 1320 nm laser at the dose of 15, 20, and 24 J/cm(2) respectively. The number of fibroblasts was counted and the levels of bFGF and TGF-β1 were detected by enzyme-linked immunosorbent assay at the time points of 0, 24, 48, and 72 h after irradiation.

RESULTS

The results showed that both the number of fibroblasts and the secretion of bFGF increased after the irradiation at the dose of 20 and 24 J/cm(2) (P<0.05) compared with that of the control cells. The bFGF secretion in the group exposed to 20 J/cm(2) was more significant than that of 24 J/cm(2), and the peak level was 24 h after irradiation. The level of TGF-β1 secretion decreased after irradiation in a dose-dependent manner (15 and 20 J/cm(2), both P<0.05; 24 J/cm(2), P<0.01), and reached a nadir at 24 h.

CONCLUSION

Our results suggested that the 1320 nm nonablative laser accelerates the vitality of fibroblasts, promotes the secretion of bFGF, and inhibits TGF-β1 secretion by fibroblasts.

Skin rejuvenation with the use of fractional photothermolysis(MultiPlex technology) in a combination with the CAP system

A new method of skin rejuvenation with the use of fractional laser photothermolysis (MultiPlex technology) in a combination with the CAP system is based on the sequential skin exposure to low-intensity radiation with different wavelengths (1,440 nm and 1,320 nm). This method produces much more evident esthetic results than radiation of greater intensity but with one wavelength only.

Right-left comparison study of hydrogel pad versus transparent fluid gel in patients with dermo-cosmetic lesions undergoing non-ablative laser therapy

OBJECTIVE

The aim of this study was to compare the cooling properties of a transparent hydrogel pad and a fluid gel in patients with dermo-cosmetic lesions undergoing non-ablative laser therapy.

METHODS

Patients enrolled in this prospective, open, randomized study had vascular or pigmented lesions in the face, v-neck or hands. The assigned test product was applied to the skin on the left side of the lesion whereas the other product was applied to the opposite side. Primary endpoints were the maximal pain intensity during laser treatment and the number of blisters and crusts after laser treatment.

RESULTS

Twenty-one patients were enrolled and underwent laser procedures using a hydrogel pad and fluid gel (16 patients with vascular and five with pigmented lesions). Maximal local pain severity was lower in all 21 patients on the side where the transparent hydrogel pad was applied (p<0.001); the transparent hydrogel pad was associated with a more cooling effect (p<0.001) and less erythema (p = 0.027). The number of crusts was similar for both test products.

CONCLUSION

Overall, laser therapy was more convenient for the patients on the side where the transparent hydrogel pad was applied. The transparent hydrogel pad offers an alternative skin cooling method worth considering for non-ablative laser therapy.

Low density, non-ablative fractional CO2 laser rejuvenation

BACKGROUND AND OBJECTIVES

Fractional skin rejuvenation has gained increased interest since its introduction in 2003. Both non-ablative and ablative lasers as well as different treatment techniques have been devised. Recent clinical studies indicate that a paradigm of low spot density combined with high fluences tend to produce better clinical results and less risk of post-inflammatory hyperpigmentation in darker skin types. The present study is focused on investigations of the clinical outcome by non-ablative fractional CO(2) treatments with a single pass with low spot density.

METHODS AND MATERIALS

A CO(2) laser was equipped with a scanner enabling it to perform fractional treatments with 36, 64 or 100 microthermal zones (MTZ)/cm(2). Twelve patients participated in the study. The perioral area was treated three times with 1-month intervals using a spot density of 64 MTZ/cm(2), a spot diameter of 0.5 mm, a micro-beam energy of 36-60 mJ, and a pulse duration of 3-5 milliseconds. Follow-up was performed 3 months after the last treatment.

RESULTS

At the 3-month follow-up 72.7% of the volunteers had obtained improvement in ultrasonographically determined dermal density, and the average improvement was 40.2% (SD: 48.0%). This improvement was statistically significant (P<0.006). Eighty percent of the volunteers rated the reduction in visible perioral wrinkles to be fair, good or excellent. For reduction of irregular pigmentation, fair, good or excellent clearance was reported by 62.5% of the volunteers.

CONCLUSIONS

The present study demonstrates subjective improvements in wrinkles, skin texture and mottled pigmentation as well as statistically significant objectively measured improvements in ultrasonographical dermal density after three non-ablative fractional CO(2) laser treatments.

Non-sequential fractional ultrapulsed CO2 resurfacing of photoaged facial skin: preliminary clinical report

This study evaluates results, adverse side effects and downtime of the protocol 'ActiveFX' for photodamaged facial skin. A non-sequential fractional ultrapulsed CO2 laser with specific settings is used in addition to a new computer pattern generator (CPG). From September 2006 to March 2007, 55 patients underwent this new 'soft' single-session, single-pass and full-face ablative fractional treatment. The patients were evaluated at baseline and 1 and 3 months after the treatment using a five-point scale. Seven aspects of photodamaged skin were recorded: global score, fine lines, mottled pigmentation, sallow complexion, tactile roughness, coarse wrinkles and telangiectasias. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Eight patients received a double-pass treatment on the crow's feet regions and the improvement of the coarse wrinkles was analyzed with a quartile grading scale. Significant differences (p<0.05) between baseline and 1 and 3 months post-treatment were observed for all features except telangiectasias. Coarse wrinkles presented a good improvement only in the regions submitted to a double-pass. Minimal and isolated adverse side effects were noted and the downtime was very low. Non-sequential fractional ultrapulsed CO2 light treatment ('ActiveFX') can be considered an excellent alternative for photodamaged facial skin.

Split-face comparison of the erbium micropeel with intense pulsed light

BACKGROUND

A variety of photorejuvenative techniques have been utilized to reverse the signs of cutaneous photoaging, including ablative and nonablative laser resurfacing as well as light-based devices.

OBJECTIVE

The purpose of this split-face randomized prospective open-label trial was to determine the effectiveness of sequential erbium:yttrium-aluminum-garnet (Er:YAG) laser versus intense pulsed light (IPL) for the treatment of mild to moderate facial photodamage.

MATERIALS AND METHODS

Ten subjects (ages 35-63) with facial dyschromia and rhytides were enrolled. Study patients were randomized to the two treatment arms, Er:YAG (3.8 J/cm(2), 30% pattern overlap, 0% interpulse overlap, 15 microm per pass with no coagulation) and IPL (560-nm filter, 30 J/cm(2), 2.4/4.0-ms pulse with 10-ms delay), each receiving three sequential treatments spaced 1 month apart. Subjective and blinded physician evaluations were performed at baseline and 4, 8, and 20 weeks posttreatment using a nominal scale from 1 to 4. Erythema and adverse events were assessed 1 week following each treatment.

RESULTS

Ten female subjects with mild to moderate facial photodamage were treated with one pass of either IPL or Er:YAG in a split-face fashion. Patients received three treatments each spaced 1 month apart. Nine of 10 patients completed the trial; 1 withdrew due to pain during the second Er:YAG treatment. Baseline subjective and blinded physician dyschromia and rhytid scores revealed no significant difference between the IPL and Er:YAG randomly assigned sides. Up to three IPL or Er:YAG treatments did not result in a significant improvement in rhytid scores. Subjective and blinded physician dyschromia scores improved 26 and 38%, respectively, 3 months after the final IPL treatment, but only by 7 and 29%, respectively, with Er:YAG. Subjective global facial appearance scores worsened by 5% while blinded physician scores improved by 16% 3 months after 3 Er:YAG treatments, but by 28 and 20% for IPL, respectively. The overall incidence of adverse events and subsequent downtime was increased for Er:YAG (1/10 patients experienced hyperpigmentation, 3/10 exfoliation, 1/10 blistering, and 5/10 discomfort) compared to IPL (1/10 exfoliation and 1/10 discomfort), although no permanent side effects were observed with either treatment arm.

CONCLUSIONS

While low-fluence erbium resurfacing has a modest effect on facial photodamage, patients preferred IPL because it resulted in less downtime. The authors have indicated no significant interest with commercial supporters.

Minimally invasive skin rejuvenation with Erbium: YAG laser used in thermal mode

BACKGROUND AND OBJECTIVES

To evaluate the efficacy and safety of a thermal mode Erbium:YAG laser several in-vivo morphological as well as clinical changes were monitored in a multi-center investigation.

STUDY DESIGN/MATERIALS AND METHODS

An Erbium:YAG laser was used at a thermal mode with sub-ablative fluences of 2.1 and 3.1 J/cm(2) with parallel air cooling to treat either periorbital, perioral rhytides or patients with post-traumatic or acne scars. Two treatments were applied 2 months apart, with follow-up at 1, 3, 6, and 12 months post-treatment. Photographs were taken before and at each follow-up visit and evaluated by three blinded independent reviewers. Histology and immunohistochemistry for pro-collagen expression were investigated. Optical coherence tomography (OCT) was performed before, and at 4, 14, and 28 days after single pass treatment with Erbium:YAG thermal pulses.

RESULTS

The improvement of rhytides at 1-3 months follow-up was graded as excellent in 19%, good in 19%, fair in 31%, and no improvement in 31%. At the 6- to 12-month follow-up, the improvement was excellent in 40%, good in 40%, fair in 20%, and no improvement in 0%. The improvement of scars at 3-6 months follow-up was graded as excellent in 50%, good in 25%, fair in 25%, and no improvement in 0%. Intra- and post-operative discomfort was described as mild by the patients. OCT, histological sections and immunohistochemistry demonstrated production of new collagen bundles.

CONCLUSIONS

Thermal Erbium:YAG pulses can induce collagen neogenesis, as proved by temperature elevation and morphological changes in the upper dermis. This leads clinically to visible and long lasting reduction of wrinkles and scars after applying multiple passes with minimal side-effects.