Single-pass carbon dioxide versus multiple-pass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates

Fractional erbium:yttrium aluminum garnet laser in the treatment of morphea mouse model

OBJECTIVE

To assess the efficiency and the mechanism of fractional erbium:yttrium aluminum garnet (Er:YAG) laser for the treatment of morphea in mouse model.

BACKGROUND

Morphea is a rare autoimmune disease characterized by excessive collagen deposition in skin. Fractional Er:YAG laser treatment is a promising treatment to improve morphea, despite limited studies about the therapeutic effect and underlying mechanism.

METHODS

The mouse model of morphea was established by subcutaneously injecting with bleomycin (BLM). A total of 24 mice received fractional Er:YAG laser treatment once a week for 4 weeks. Objective measurement employed was ultrasonic imaging to measure dermal thickness. Subjective measures included scoring according to the adjusted Localized morphea Cutaneous Assessment Tool (LoSCAT); hematoxylin and eosin (H&E) staining to evaluate the histological grade of fibrosis; and quantitative morphometric studies to determine the expression of transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase-1 (MMP1) by immunohistochemistry.

RESULTS

In this self-controlled study, fractional Er:YAG laser treatment significantly ameliorate the severity of morphea, including lower clinical score (p < 0.01), decreased dermal thickness (p < 0.001), declined histological grade of fibrosis (p < 0.001), increased MMP1 (p < 0.001), and reduced TGF-β1 (p < 0.01) expression.

CONCLUSIONS

We found that fractional Er:YAG laser treatment of morphea has good clinical, ultrasonic, and histopathologic efficacy, which may be a promising treatment in the future.

The quantitative investigation of spark plasma on skin parameters with skin elasticity, thickness, density, and biometric characteristics

Cold atmospheric plasma has been developed and utilized as a novel technique for skin rejuvenation because of its various effects on cells and living things. This study investigated the accuracy of this claim and any possible side effects of using spark plasma to rejuvenate skin. The present work is the first quantitative investigation using animal models. 12 Wistar rats were divided into two groups for this investigation. To compare the skin's natural process with the treated skin, the first group underwent a single session of plasma therapy, while the second group served as the control group. The back of the necks of the samples was shaved for 20 cm. Before beginning treatment, the MPA9 multifunctional skin tester was used to determine the melanin index, erythema index, and transepidermal water loss (TEWL). The skin's thickness and density were assessed using sonography, and its elasticity index was calculated using a Cutometer. The samples were exposed to plasma radiation in the designated area (in a triangular pattern). The abovementioned signs were examined immediately after the following therapy and at the weekly appointment 2-4 weeks later. Optical spectroscopy was also used to demonstrate the presence of active species. In this study, we found that a plasma spark therapy session significantly boosts skin elasticity, and the ultrasound results revealed a significantly increased skin thickness and density. The plasma increased the amount of skin surface evaporation, erythema, and melanin immediately following the treatment. However, 4 weeks later, it recovered to its former state and did not differ significantly from before the therapy.

Dermatologic Laser Side Effects and Complications: Prevention and Management

The evolution of modern laser and light-based systems has mirrored the demand for clinically effective treatments and the need for safer technologies with reduced postoperative recovery, side effects, and complications. With each new generation of lasers, more selective tissue destruction can be achieved with reduced unwanted sequelae. Patient selection and preparation, operator technique, and expeditious recognition and management of post-treatment side effects are paramount in avoiding complications and patient dissatisfaction. An overview of important variables to consider for dermatologic laser treatments are presented in order to provide a framework to reduce the severity and duration of possible post-treatment side effects and complications.

Fractional Erbium-YAG Laser and Platelet-Rich Plasma as Single or Combined Treatment for Atrophic Acne Scars: A Randomized Clinical Trial

INTRODUCTION

Acne scarring is a common undesirable complication of acne vulgaris. Fractional erbium-yttrium aluminum garnet (YAG) 2940 nm laser and platelet-rich plasma have been used in treating acne scars with variable outcomes. The objective of this study is to assess the efficacy of fractional erbium-YAG 2940 nm laser and platelet-rich plasma as a single line of treatment in comparison with combined treatment in atrophic postacne scars.

METHODS

Seventy-five patients were included in this trial and randomized into three equal groups (25 each). Group A was subjected to six sessions of erbium-YAG laser for 6 months, group B was treated with 12 sessions of platelet-rich plasma over the same period, and group C was subjected to six sessions of erbium-YAG laser plus 12 sessions of platelet-rich plasma over the same period. Each subject was evaluated by acne scar grading, photography, and subjective evaluation.

RESULTS

Both treatment modalities showed improvement of acne scars, but the improvement with combined treatment was better than that with erbium-YAG laser or platelet-rich plasma alone regarding scar grade improvement (P = 0.007 and 0.001), clinical improvement (P = 0.001 and 0.001), and patient satisfaction (P = 0.005 and 0.001), respectively.

CONCLUSIONS

The combination of platelet-rich plasma plus erbium-YAG laser is superior to either treatment alone for acne scars, with trivial side effects for all treatment modalities.

TRIAL REGISTRATION

ClinicalTrials.gov identifier; NCT03933033.

Dermatologic care of sexual and gender minority/LGBTQIA youth, Part 2: Recognition and management of the unique dermatologic needs of SGM adolescents

Sexual and gender minority (SGM) individuals, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) persons, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Part 2 of this two-part review will address unique concerns regarding acne, tanning behavior, sexually transmitted infections, and other health disparities among SGM adolescents. A more comprehensive understanding of the dermatologic needs of SGM youth will better allow pediatric dermatologists to actively and compassionately care for this health disparity population.

New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency

Objective

To evaluate the clinical response of patients with symptoms of genitourinary syndrome of menopause after application of microablative fractional radiofrequency in the vagina and vaginal introitus.

Methods

Fourteen patients with symptoms of genitourinary syndrome of menopause underwent three applications of microablative fractional radiofrequency with a 30-day interval, using the Wavetronic 6000HF-FRAXX device and a fractional vaginal electrode. The questionnaires World Health Organization Quality of Life (for quality of life evaluation), Female Sexual Function Index and Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (for sexual function and satisfaction evaluation) were administered before and after the applications (30 to 60 days after the last procedure), in addition to the satisfaction questionnaire after procedure.

Results

There was an increase in almost all dimensions on average in quality of life, with statistical significance only in the health domain. There was a significant improvement in the sexual domains in almost all dimensions. All patients stopped using lubricant during intercourse after treatment. In the satisfaction questionnaire after treatment, we observed that the vast majority felt cured or much better (29% and 64%, respectively, total of 92.6%) and were very satisfied or satisfied (43 and 57%, respectively, total of 100%). The only patient who reported little improvement had an 18-year postmenopausal history and was treatment naïve.

Conclusion

Microablative fractional radiofrequency was effective in treating symptoms of vaginal dryness and dyspareunia, and eliminated the use of vaginal lubricant during the period observed. Since this is a pilot study with a small number of patients, further studies are required to corroborate our findings and evaluate the long-term effects of microablative fractional radiofrequency on the vaginal tissue.

[Laser treatment of basal cell carcinoma]

With a clear increase in the incidence and a continuously earlier onset, the main risk factors for the development of basal cell carcinoma are still exposure to sunlight, fair skin, immunosuppression, carcinogens such as arsenic, chronic irritations and certain genodermatoses. Treatment options for localized resectionable basal cell carcinoma include micrographically controlled surgery, simple excision, curettage, laser ablation, cryosurgery, imiquimod, 5‑fluorouracil, photodynamic treatment and radiotherapy. Non-surgical treatment options are more suited for cases in which surgical procedures lead to disfigurement or functional impairments or for patients with a high surgical risk. Laser treatment, ablative and non-ablative as monotherapy or in combination can represent a meaningful treatment option in selected cases. In recent years there has been an increase in knowledge about the indications and effects of laser treatment of basal cell carcinoma; nevertheless, further studies with a high level of evidence are necessary.

The role of lasers and intense pulsed light technology in dermatology

The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.

Selected applications of Er:YAG and CO2 lasers for treatment of benign neoplasms and tumorous lesions in the mouth

INTRODUCTION

Benign neoplasms and hyperplastic tumorous lesions are common oral pathologies. These lesions require to be surgically removed by conventional surgery, laser, or electrosurgery. Surgical treatment aims at complete removal of pathological lesions and ensuring proper healing of the tissues to minimize the risk of lesion recurrence.

AIM

To present possible applications of Er:YAG and CO2 lasers in removal of benign neoplasms and tumorous lesions developing on oral mucosa as well as to specify indications and limitations of these two methods.

MATERIAL AND METHODS

Temperature-induced injuries due to laser light application, possibility of post-operative histopathological evaluation of the removed tissue, efficacy of the cut and coagulation, healing process and completeness of laser surgeries give rise to our special concern.

RESULTS

The main asset of the CO2 laser comparing to Er:YAG laser is an effective coagulation while thermal injury to the tissues is its limitation, especially with multiple passage of the beam and too high power applied. Er:YAG laser application does not exclude histopathological examination of the removed lesion tissue which is its advantage over CO2 laser.

CONCLUSIONS

Still, insufficient coagulation is a limitation ofits use in the case of richly vascularized lesions.

Confocal imaging of carbon dioxide laser-ablated basal cell carcinomas: An ex-vivo study on the uptake of contrast agent and ablation parameters

BACKGROUND AND OBJECTIVES

Laser ablation can be an effective treatment for the minimally invasive removal of superficial and early nodular basal cell carcinomas (BCCs). However, the lack of histological confirmation after ablation results in high variability of recurrence rates and has been a limitation. Reflectance confocal microscopy (RCM) imaging, combined with a contrast agent, may detect the presence (or absence) of residual BCC tumors directly on the patient and thus provide noninvasive histology-like feedback to guide ablation. The goal of this ex vivo bench-top study was to determine affective ablation parameters (fluence, number of passes) for a CO2 laser that will allow both removal of BCCs and control of the underlying thermal coagulation zone in post-ablated tissue to enable uptake of contrast agent and RCM imaging.

MATERIALS AND METHODS

We used 72 discarded fresh normal skin specimens and frozen BCC tumor specimens to characterize the depth of ablation and to evaluate uptake of contrast agent and image quality. Acetic acid was used to enhance nuclear brightness ("acetowhitening") during imaging pre- and post-ablation. Histology sections of the post-ablated imaged surface were visually examined for the appearance of nuclear and dermal morphology and compared to the RCM images.

RESULTS

Results for 1-3 passes of 5.5 J/cm(2), 6.5 and 7.5 J/cm(2), and 1-2 passes of 8.5 J/cm(2) showed the uptake of acetic acid for contrast and RCM imaging of the presence and absence of residual BCC tumors in post-ablated tissue. Morphologic details in the images were validated by the histology.

CONCLUSION

The use of effective ablation parameters may enable RCM imaging to guide ablation.

Usefulness of Skin Explants for Histologic Analysis after Fractional Photothermolysis

Background

Fractional laser resurfacing treatment has been extensively investigated and is widely used. However, the mechanism underlying its effects is poorly understood because of the ethical and cosmetic problems of obtaining skin biopsies required to study the changes after laser treatment.

Objective

To evaluate the usefulness of human skin explants for the investigation of fractional photothermolysis.

Methods

Full-thickness discarded skin was treated in 4 ways: no treatment (control), fractional carbon dioxide laser, fractional Er:YAG laser, and fractional 1,550-nm erbium-doped fiber laser. Both treated and non-treated skin samples were cultured ex vivo at the air-medium interface for 7 days. Frozen tissue was sectioned and stained with hematoxylin & eosin for histologic examination and nitro blue tetrazolium chloride for viability testing.

Results

Skin explants cultured for up to 3 days exhibited histologic changes similar to those observed in in vivo studies, including microscopic treatment zones surrounded by a thermal coagulation zone, re-epithelialization, and formation of microscopic epidermal necrotic debris. However, the explant structure lost its original form within 7 days of culture. The viability of skin explants was maintained for 3 days of culture but was also lost within 7 days.

Conclusion

The skin explant model may be a useful tool for investigating the immediate or early changes following fractional photothermolysis, but further improvements are required to evaluate the long-term and dermal changes.

Will nonablative rejuvenation replace ablative lasers? Facts and controversies

Since the early 1980s, the field of skin rejuvenation has evolved rapidly. Traditional ablative resurfacing with carbon dioxide and Er:YAG lasers offered dramatic improvement of the skin tone and texture, but prolonged postoperative period and an increased risk for side effects and complications were unacceptable for the majority of patients. It prompted the development of nonablative lasers and non-laser systems, which stimulate dermal neocollagenesis without epidermal disruption, and therefore, produce less adverse effects with little or no healing time. Recently, fractional nonablative and ablative lasers have been introduced, employing a completely new concept of fractional photothermolysis, which ensures high efficacy and fewer risks. Ablative laser resurfacing still remains the gold standard for treating advanced and severe photoaging providing excellent results in experienced hands. Alternatively, ablative fractional resurfacing can be used, with the results, which are comparable to fully ablative lasers with better standard of safety. Nonablative resurfacing is ideal for patients under the age of 50 years with minimal facial sagging, and for those who are unwilling to undergo expensive and demanding ablative procedures. It can be concluded that the key of therapeutic success is in proper patient selection, setting appropriate expectations and combining different rejuvenation technologies with other therapeutic modalities, such as botulinum toxin and fillers.

Management of acne scarring, part I: a comparative review of laser surgical approaches

Acne scarring is the result of a deviation in the orderly pattern of healing and can have profound psychosocial implications for patients. While the most effective means of addressing acne scarring is to prevent its formation through good acne control, there are a number of therapeutic interventions that improve the appearance of acne scars. Many of these procedural modalities have flaws and are limited by operator skill and experience. Laser scar revision, on the other hand, is a precise, well tolerated procedure with clinically demonstrable efficacy and minimal adverse effects that may be used alone or in combination with other scar treatments. The last 20 years has seen a dramatic evolution in laser treatment of acne scars, spanning ablative and nonablative technologies, to the current popularity of fractional laser scar revision. Determining which laser system to use depends upon the type and severity of acne scarring, the amount of recovery a patient can tolerate, and the ultimate goals and expectations of each patient. The importance of proper acne scar classification, laser scar revision techniques, and the evidence that addresses each laser system is reviewed in this article.

Superficial wounding model for epidermal barrier repair studies: comparison of Erbium:YAG laser and the suction blister method

BACKGROUND AND OBJECTIVES

Wound-healing studies use mainly mechanical methods for wound induction, which are laborious and difficult to standardize. Objective of this study was to evaluate the Erbium:Yttrium-Aluminium-Garnet (Er:YAG) laser method as a model of epidermis ablation on human skin in vivo and to compare the quality and healing rates of Er:YAG laser and suction blister (SB) wounds.

MATERIALS AND METHODS

Er:YAG laser and SB wounds were made on the forearms of 10 healthy volunteers. Post-wounding measurements including wound surface area (WSA) from photographs, wound depth from 3D volume analysis, trans-epidermal water loss (TEWL), laser doppler blood flow (LDBF), and optical coherence tomography (OCT) imaging were made daily over 7 days. Biopsies were taken on Days 4 and 7.

RESULTS

3D analysis showed laser wounds to be shallower and more uniform in depth than SB: 54 ± 14 µm versus 140 ± 102 µm, respectively, with histology demonstrating complete epidermal removal using SB. SB wounds were more variable in size with a WSA of 0.47 ± 0.24 cm(2) compared to 1.17 ± 0.14 cm(2) for laser wounds. Healing rates were similar in both groups, as measured by TEWL, LDBF, and WSA. OCT imaging on Days 3-4 revealed new epidermis below the fibrin clot, similar to histology, and a visible stratum corneum on Day 7, but no apparent epidermal hyperplasia in contrast to histology.

CONCLUSION

Compared to the SB model, Er:YAG laser achieved rapid standardized epidermal ablation, which despite morphological differences, was similar in terms of epidermal regeneration/barrier formation.

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.

Versatility of erbium YAG laser: from fractional skin rejuvenation to full-field skin resurfacing

For the laser surgeon, the Er-YAG laser is an invaluable tool that delivers unsurpassed ablation efficiency, and with appropriate functionality (quasi long-pulse feature) provides sufficient tissue coagulation to remodel deep rhytids. As such, the 2940-nm wavelength is well suited for routine laser skin rejuvenation in full-field, fractional, and point-beam modes with additional benefits, including applicability to diverse skin types, short healing times, and a low likelihood of energy-related complications.

Carbon dioxide laser guidelines

The carbon dioxide (CO(2)) laser is a versatile tool that has applications in ablative lasing and caters to the needs of routine dermatological practice as well as the aesthetic, cosmetic and rejuvenation segments. This article details the basics of the laser physics as applicable to the CO(2) laser and offers guidelines for use in many of the above indications.

TUNEL assay to characterize acute histopathological injury following treatment with the active and deep FX fractional short-pulse CO2 devices

BACKGROUND

This is a report of the histopathological evaluation of the acute damage profile in human skin following treatment with two novel short-pulsed fractional carbon dioxide resurfacing devices used independently and in combination in vivo.

METHODS

The panni of eight abdominoplasty patients were treated with either the Active FX, the Deep FX (Lumenis Ltd., Yokneum, Israel), or a combination of the two (Total FX) prior to the start of the excisional surgical procedure. Multiple combinations of energies, pulse widths, and densities were evaluated for each device. After surgical removal (two to five hours), each pannus was immediately biopsied and samples were processed for histopathological evaluation.

RESULTS

The Active FX system resulted in extensive epidermal injury with wide shallow ablation craters that, at higher fluences, extended through the basement membrane of the epidermis into the papillary dermis. The Deep FX fractional treatment caused deep microcolumns of ablation penetrating up to 3 to 4 mm from the epidermal surface into the deep reticular dermis with a variable rim of coagulated collagen surrounding each ablation column.

CONCLUSIONS

The in vivo histopathological evaluation of these devices furthers our understanding of the fundamental laser/tissue interaction following treatment with each device independently and in combination.

Systematic evaluations of skin damage irradiated by an erbium:YAG laser: histopathologic analysis, proteomic profiles, and cellular response

BACKGROUND

The erbium:yttrium-aluminum-garnet (Er:YAG) laser is used for surgical resurfacing. It has ablative properties with water as its main chromophore.

OBJECTIVE

This study attempted to establish the cutaneous effect and cellular response to Er:YAG laser irradiation using different fluences (7.5 and 15 J/cm(2)).

METHODS

Female nude mouse was used as the animal model in the study. Physiological parameters were examined and histology was evaluated at 4, 24 and 96 h after laser exposure. A proteomic analysis and immunoblotting were also used to determine the mechanisms of the laser's effect on the skin.

RESULTS

Both fluences were associated with a significant increase in transepidermal water loss (TEWL), erythema (a*), and the skin pH at 4 and 24h. In contrast, at 96 h, the levels of these parameters had generally decreased to the baseline. The histology examined by light microscopy and transmission electron microscopy (TEM) showed vacuolization, hydropic degeneration and epidermal necrosis of laser-irradiated skin. The higher fluence (15 J/cm(2)) exhibited more-severe disruption of the skin. Bulous and scarring were observed in skin treated with the higher fluence during the recovery period. p53 and p21 proteins were significantly activated in skin following exposure to the laser. However, proliferating cell nuclear antigen and cytokeratin expressions were downregulated by the low fluence (7.5 J/cm(2)).

CONCLUSION

Both proliferation and apoptosis occurred when the laser-irradiated the skin.

Laser treatment of acne, psoriasis, leukoderma, and scars

Lasers frequently are used by dermatologists for their multiple aesthetic applications, but they also can be used to treat a variety of medical dermatology conditions. Conditions such as acne vulgaris, psoriasis, and vitiligo can all be successfully treated with laser, thereby providing the patient with additional therapeutic options. Lasers have also been used for years to improve the appearance of scars. The newer fractionated lasers have been especially effective in enhancing the clinical outcomes of scar revision.

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.

The management of postacne scarring

BACKGROUND

Therapeutic intervention for postacne scarring has historically been limited by the considerable morbidity of most treatments for only marginal disease improvement. Within the past decade, however, a greater understanding of the pathogenesis of acne scarring has led to the development of techniques that offer more favorable risk-benefit profiles.

OBJECTIVE

The aims of this article are to highlight a number of newer techniques and to assign their appropriateness to particular grades of acne scarring.

MATERIALS AND METHODS

Current modalities are discussed as they relate to disease process and specific acne scar types. Techniques are presented in order of most effectual therapeutic interventions for defined grades of acne scarring. Acne scarring grades have been described previously in terms of disease load, severity, and lesion morphologies.

RESULTS

A comprehensive discussion of updated therapeutic techniques and their biologic rationales in the treatment of acne scarring is presented. These include targeted interventions of inflammatory and postinflammatory processes, angiogenesis, immunologic processes, dermal and subcutaneous fibrosis, hypertrophy, and keloid scarring.

DISCUSSION

A requirement for developing successful treatments for postacne scarring is a greater understanding of its pathogenesis, variability among afflicted individuals, and the inflammatory mediators and immunology of the scarring process. Many innovative techniques introduced in the past decade attempt to counteract these pathologic processes while keeping the procedural and postoperative risks to a minimum.

Aging Skin: Causes, Treatments, and Prevention

Intrinsic and extrinsic aging of the skin follow different pathways, but the end result is similar. Treatment options include cosmeceuticals, laser rejuvenation, chemical peels, and microdermabrasion. Preventing the effects of extrinsic aging involves using sunscreen-the right product, used in the right amount, at the right time, in the right places.

Long-Term Efficacy of Carbon Dioxide Laser Resurfacing for Facial Actinic Keratosis

PURPOSE

To evaluate the efficacy and long-term effectiveness of carbon dioxide laser resurfacing in the treatment of patients with facial actinic keratosis.

PATIENTS AND METHODS

A retrospective chart analysis was conducted of 31 patients who underwent full face carbon dioxide laser resurfacing for facial actinic keratosis from July 1998 to November 2002.

RESULTS

Of 31 patients, 18 (58%) were free of lesions at their longest visit. The average actinic keratosis free period, excluding 2 deceased patients, was 27.4 months.

CONCLUSION

Carbon dioxide laser resurfacing is an effective tool in the management of patients with facial actinic keratosis.

Fractional Photothermolysis: A Novel Aesthetic Laser Surgery Modality

The ubiquity of increased sun exposure, oral contraceptives, and phototoxic drugs has led to an increased prevalence of conditions such as dyschromia, melasma, rhytides, and other signs of photoaging over the past few decades. Through the application of selective photothermolysis, laser surgery has attempted to create therapeutic options for these medically recalcitrant conditions. To date, however, this technology has been met with limited success, due to a high incidence of posttreatment side effects, inability to treat off the face, and a safety profile tailored to Fitzpatrick skin types I to III. More recently, a novel approach coined "fractional photothermolysis" was developed in an attempt to overcome these limitations. This new laser treatment modality has allowed for effective treatment of a diverse array of dermatologic conditions on and off the face with a wider therapeutic index and improved safety profile independent of Fitzpatrick skin type. This review sheds light on the technical aspects, biologic mechanisms, and clinical effects of fractional photothermolysis that help set it apart from previous modes of laser surgery.

Providing pain relief for laser resurfacing: Effectiveness of the CoolAnalgesia© device

Laser resurfacing is a painful procedure, and is therefore usually carried out under general anaesthetic or local anaesthetic with sedation. However, the small but significant risk of adverse events from either of these methods has resulted in an effort to develop other methods of controlling the pain associated with the use of lasers. This trial describes of the use of a cooling device (the CoolAnalgesia device) with a carbon dioxide laser. The only anaesthetic used was a eutectic mixture of lidocaine anaesthetic (EMLA) applied as a cream to the face at least 60 min prior to the procedure. Twenty consecutive patients attending two laser centres for facial resurfacing were recruited. Each patient was asked to assess the level of pain on a visual analogue scale from 1-10 every 2 min during lasering. Only one of the patients had a mean pain score for the duration of the treatment of above five, four patients recorded a pain score of above five at some stage during their treatment, but none requested that the treatment be stopped. It would appear that the CoolAnalgesia device in combination with EMLA cream provides a level of anaesthesia sufficient to allow laser resurfacing without the use of local anaesthetic injections or intra-venous agents.

LASER-tissue interactions

As new laser devices continue to emerge, it becomes increasingly important for the clinical dermatologist to understand the basic principles behind their operation. A fundamental understanding of how lasers interact with tissue will enable the physician to choose the most appropriate laser for a given clinical situation. Although the physical laws guiding laser design are vastly complex, the fundamental principles of laser-tissue interaction can be summarized as they are applicable to the clinician.

Lasers for scars: a review

Many articles have been published on improving the appearance of scars; however, there are no definitive management protocols. Our objective was to review the literature on laser therapy for various types of scars. There are multiple laser modalities that have been studied with certain features that may be indicated for specific scar types. Suggestions are given for further studies.

Ablative facial resurfacing

Ablative resurfacing is a powerful tool for rejuvenation of the aging face and for the treatment of a wide array of skin lesions. In the proper hands, it is a safe and effective way to treat many of the problems of photodamaged skin that surgery or nonablative methods cannot address. This article discusses the three most common modalities used in ablative facial resurfacing: chemical peels, dermabrasion, and laser resurfacing. Indications, mechanism of action, techniques, results, and complications all are reviewed.

Ablative treatment of photoaging

Despite the burgeoning options available for skin rejuvenation, the benefits of laser skin resurfacing in trained hands remains unequaled. This article will review the preoperative evaluation, lasers and techniques used, postoperative course, and possible complications.

Nonablative 1450-nm diode laser in the treatment of facial atrophic acne scars in type IV to V Asian skin: a prospective clinical study

BACKGROUND

There is presently little published data on the clinical effectiveness of nonablative lasers in the treatment of atrophic acne scars and the safety of their use in patients with darker skin types.

OBJECTIVE

This study aims to determine the clinical effectiveness and safety of the nonablative 1450 nm diode laser with cryogen cooling spray in the treatment of facial atrophic acne scars in Type IV-V Asian skin.

METHODS

This is a prospective non-comparative open study. 4 to 6 laser treatment sessions were performed on patients with atrophic acne scars. Final clinical assessment was performed 6 months after the last treatment.

RESULTS

57 patients were evaluated. Patient's self-assessment of scar improvement as compared with doctor's assessment was as follows: patients who completed 4 treatments (15.7% vs 6.6%), patients who completed 5 treatments (20% vs 7.9%) and patients those who completed 6 treatments (17.3% vs 5.0%). Main side effects were mild to moderate pain during the procedure, transient erythema, and hyperpigmentation which occurred in 39% of treated patients.

CONCLUSION

The nonablative 1450 nm diode laser may be effective in achieving mild to moderate gradual clinical improvement in the treatment of facial atrophic acne scars. The procedure is associated with minimal downtime and is safe for use in darker skin types IV and V.

Combination surgical lifting with ablative laser skin resurfacing of facial skin: a retrospective analysis

BACKGROUND

Cutaneous aging is manifested by rhytides, dyschromias, and skin laxity. Ablative laser skin resurfacing can effectively improve many signs of skin aging; however, the photoaged patient with facial laxity often requires a surgical lifting procedure in order to obtain optimal results. Concerns with delayed or impaired wound healing has led to reluctance to perform both procedures simultaneously.

OBJECTIVE

To report the clinical results and side effect profiles after concomitant surgical facial lifting procedures and ablative carbon dioxide or erbium:YAG laser resurfacing in a series of patients.

METHODS

A retrospective analysis and chart review was performed in 34 consecutive patients who underwent combination CO(2) or erbium:YAG laser skin resurfacing and surgical lifting procedures, including S-lift rhytidectomy, blepharoplasty, and brow lift. Side effects and complication rates were tabulated.

RESULTS

The side effect profile of the combined surgical-laser procedures was similar to that reported after a laser-only procedure. The most common side effect was transient hyperpigmentation which occurred in 20.6% of treated patients. None of the patients experienced delayed reepithelialization, skin necrosis, or prolonged healing times.

CONCLUSIONS

Concurrent laser skin resurfacing and surgical lifting of facial skin maximizes aesthetic results without increased incidence of adverse effects. Patients benefit from the consolidation of anesthesia and convalescent times as well as enhanced global clinical outcomes.

Resurfacing of different types of facial acne scar with short-pulsed, variable-pulsed, and dual-mode Er:YAG laser

BACKGROUND

Laser skin resurfacing has become a popular therapeutic modality for the correction of acne scars, but it is not always effective in all types of acne scars.

OBJECTIVE

To evaluate the clinical effects of resurfacing with the short-pulsed Er:YAG laser, the variable-pulsed Er:YAG laser, and the dual-mode Er:YAG laser for each type of facial acne scars.

METHODS

One hundred fifty-eight patients with facial acne scars were included in this study. Eighty three patients (18 deep boxcar scars, 8 ice-pick scars, 11 rolling scars, and 46 shallow boxcars) were treated with the 350-micros short-pulsed Er:YAG laser at the setting of 12.5 to 15%/cm(2). Thirty-five patients (8 deep boxcar scars, 4 ice-pick scars, 12 rolling scars, and 11 shallow boxcars) were treated with the variable-pulsed Er:YAG laser at the setting of 7.0 to 7.5%/cm(2) and 7-ms pulse duration. Forty patients (8 deep boxcar scars, 4 ice-pick scars, 17 rolling scars, and 11 shallow boxcars) were treated with the dual-mode Er:YAG laser with 350-micro ablation mode at 17.5%/cm(2) and 8-ms coagulation mode at 3.15%/cm(2). Facial photographs were obtained at baseline and at 2- to 4-week intervals postoperatively. Acne scars were classified into four types, and clinical improvements of facial acne scars were evaluated.

RESULTS

Resurfacing with the short-pulsed Er:YAG laser shows good to excellent results for ice-pick and shallow boxcar scars, fair to good for deep boxcar scars, and poor to fair for rolling scars. Resurfacing with the variable-pulsed laser shows good to excellent results for ice-pick and shallow boxcar scars, fair to good for deep boxcar scars, and good for rolling scars. Resurfacing with the dual-mode laser shows good to excellent results for ice-pick, shallow, and rolling scars and produced good results on deep boxcar scars.

CONCLUSION

Shallow boxcar and ice-pick scars can be treated successfully using any types of Er:YAG laser. In cases of rolling and deep boxcar scars, however, Er:YAG laser with a long-pulse duration for a thermal effect is needed for successful treatment.