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.

Character of skin on photo-thermal response and its regeneration process using second-harmonic generation microscopy

Quantitative characterization of skin collagen on photo-thermal response and its regeneration process is an important but difficult task. In this study, morphology and spectrum characteristics of collagen during photo-thermal response and its light-induced remodeling process were obtained by second-harmonic generation microscope in vivo. The texture feature of collagen orientation index and fractal dimension was extracted by image processing. The aim of this study is to detect the information hidden in skin texture during the process of photo-thermal response and its regeneration. The quantitative relations between injured collagen and texture feature were established for further analysis of the injured characteristics. Our results show that it is feasible to determine the main impacts of phototherapy on the skin. It is important to understand the process of collagen remodeling after photo-thermal injuries from texture feature.

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.

Heat shocks enhance procollagen type I and III expression in fibroblasts in ex vivo human skin

BACKGROUND

The well-known characteristics of aging skin are the development of fine lines and wrinkles, but changes in skin tone, skin texture, thickness and moisture content are also aspects of aging. Rejuvenation of the skin aims at reversing the signs of aging and can be established in the epidermis as well as in the dermis. Aged dermis, in fact, has a degenerated collagen matrix. To regenerate this matrix, fibroblasts need to be stimulated into synthesizing new collagen.

AIMS

In this study, the effects of heat shocks of different temperatures on human dermal fibroblasts in ex vivo skin on the expression of procollagen 1, procollagen 3, heat shock protein (hsp)27, hsp47, and hsp70 are investigated.

MATERIALS AND METHODS

The heat shocks were applied on ex vivo skin samples by immersing the samples in heated phosphate-buffered saline of 45 °C or 60 °C. Metabolic activity was measured and at similar time points propidium-iodide-calceine staining was performed to establish cell viability. Quantitative polymerase chain reaction (qPCR) was performed after the heat shock to determine gene expression levels relative to the reference temperature. Furthermore, PicroSirius Red and hematoxylin stainings were performed to visualize the collagen network and the cells.

RESULTS

The skin samples were shown to be viable and metabolically active. Histology indicated that the heat shocks did not influence the structure of the collagen network or cell appearance. qPCR results showed that in contrast to the 45 °C heat shock the 60 °C heat shock resulted in significant upregulations of procollagen type I and III, hsp70 and hsp47.

CONCLUSION

A 60 °C, heat shock stimulates the human dermal fibroblasts in ex vivo skin to upregulate their procollagen type I and type III expression.

Pulsed heat shocks enhance procollagen type I and procollagen type III expression in human dermal fibroblasts

BACKGROUND

The formation of wrinkles is associated with degeneration of the collagen matrix. For regeneration of the matrix, fibroblasts need to be stimulated in producing new collagen.

AIMS

In this study, the effect of short-pulsed heat shocks on gene expression of procollagen type I, procollagen type III, heat shock protein (hsp)27, hsp47 and hsp70 and on the expression of remodeling markers, procollagen type I carboxy-terminal peptide (P1P) and carboxy-terminal telopeptide of type I (ICTP), of human dermal fibroblasts in vitro, is investigated.

MATERIALS AND METHODS

Temperatures of 45 degrees C and 60 degrees C were used for the heat shocks. The proliferation rates, viability and metabolic activity were measured directly after the pulsed heat shocks and quantitative PCR was performed at five different time points after the heat shocks. Enzyme Immuno Assays were performed to determine the concentrations of P1P and ICTP.

RESULTS

A decreased proliferation rate of the 60 degrees C heat shocked cells was shown, whereas the viability and metabolic activity did not differ. Furthermore, gene expressions were upregulated in both 45 degrees C and 60 degrees C heat-shocked cells. However, remodeling marker analyses showed a larger amount of collagen produced by 60 degrees C heat-shocked cells.

CONCLUSION

It can be concluded that these findings, together with upregulation in gene expression, show that it is possible to stimulate the cells to produce more collagen with short-pulsed heat shocks.

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.

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.