New application of the long-pulsed Nd-YAG laser as an ablative resurfacing tool for skin rejuvenation: a 7-year study

Expert consensus on perioperative integrated skincare for noninvasive energy-based device aesthetic procedures in clinical practice in China

BACKGROUND

Noninvasive energy-based device (NI-EBD) aesthetic procedures has recently gained widespread usage for treating various skin conditions, enhancing skin texture and performing rejuvenation-related procedures. However, practically all NI-EBD procedures result in variable degrees of damage to the skin barrier, inducing pathological and physiological processes such as oxidative stress and inflammation, and only a small percentage of individuals possess the innate ability to restore it.

OBJECTIVE

To introduce the concept of integrated skincare and establish standardized operational procedures for perioperative integrated skincare, and furnish a theoretical basis for clinical diagnosis and treatment performed by professional medical aestheticians.

METHODS

The author leveraged domestic and international guidelines, clinical practice expertise and evidence-based research, adapting them to suit the specific circumstances in China.

RESULTS

The consensus were provided four parts, including concept and essence of integrated skincare, integrated skincare significance during the perioperative phase of NI-EBD procedures, active ingredients and functions of effective skincare products, standardized perioperative skincare procedure for NI-EBD procedures and precautions. For the standardized perioperative skincare procedure, four recommendations were listed according to different stages during NI-EBD procedures.

CONCLUSION

These recommendations create the 'Expert Consensus on Perioperative Integrated Skincare for Noninvasive Energy-Based Device Aesthetic Procedures in Clinical Practice in China'.

Skin rejuvenating effect of a combined triple-wavelength (755 nm, 810 nm, and 1064 nm) laser: a preliminary study

With an increasing demand for noninvasive skin rejuvenation techniques, several light-based devices have been introduced. Due to its ability to deliver thermal energy from the superficial to deeper levels of the dermis, a combined triple-wavelength laser (755 nm, 810 nm, and 1064 nm) can be used for skin rejuvenation. The objective of this study was to assess the effectiveness and safety of a combined triple-wavelength laser for skin rejuvenation. A total of 28 female patients seeking skin rejuvenation treatment were included. All patients underwent five consecutive treatment sessions at a two-week interval. Clinical improvement of aging-related cutaneous change was noted by the treating dermatologists and patients. Biopsies were performed on the faces of consenting patients before and two weeks after the final treatment. Significant clinical improvements were observed by both patients and evaluating dermatologists. Based on the patient satisfaction questionnaire, 78% of patients reported a self-assessed improvement of more than 25%. Additionally, 86% of patients showed an improvement of more than 25% on objective assessment by dermatologists. Histopathological findings revealed increased collagen and elastic bundles throughout the dermis. Except for transient pain during treatment, no serious adverse effects were reported. The findings of this study suggest that the combined triple-wavelength laser may be an effective and safe nonablative option for skin rejuvenation.

Molecular Features of Hypertrophic Scars After Thermal Injury: Is There a Biologic Basis for Laser Therapy?

Significance: Hypertrophic scars (HTS) and keloids are common after thermal injuries and other trauma to deep regions of dermis of the skin. These abnormal scars can cause contractures and the thick masses of scar tissue that result in functional and cosmetic impairment. Management of these dermal fibrotic conditions includes a wide range of medical and surgical treatments, which can be time consuming, only partially effective, and often uncomfortable for patients. Recent Advances: The molecular pathophysiology of HTS has become more understood over the past two decades, where thermal injury to the reticular dermis results in an inflammatory response, fibrogenic growth factor release, and the formation of a dermal scar with increased collagen and proteoglycan composition in an abnormal morphology. Lasers are becoming a widely used form of treatment for these types of scars; however, the evidence for the beneficial effects of laser treatments and the understanding of their mechanism of action are still evolving. Critical Issues: Paradoxically, laser delivery of thermal energy to the skin is suggested to improve scar remodeling and wound healing, yet HTS is a well-recognized complication of excessive thermal energy delivered by laser treatments. This review aims to examine the current evidence for the use of lasers for HTS, and to investigate the molecular mechanisms where re-injury of a burn scar from laser treatment could result in overall improvements in scar quality. Future Directions: Improved design of clinical trials for the treatment of scarring in the future will evolve from new methodology and models of HTS in animals and humans.

Split-face clinical comparative study of fractional Er:YAG (2940nm) laser versus long pulsed Nd:YAG (1064nm) laser in treatment of atrophic acne scar

Despite various modalities used for treating acne scars, no single treatment modality was significantly satisfactory. We compare the efficacies of fractional Erbium: yttrium aluminum garnet (Er:YAG), 2940 nm, laser versus long-pulsed Neodymium: yttrium-aluminum-garnet (Nd:YAG), 1064 nm, laser for the treatment of acne scars. Twenty patients were treated in a randomized split-face manner. They underwent three sessions at a three-week interval. Assessment of the patient was done before each treatment and 3 months after the end of the treatment sessions. The treatment effect was evaluated objectively, according to Sharquie scores for grading scarring acne vulgaris and digital photographic assessment and subjectively, according to the patient's satisfaction. Results According to objective Sharquie scores, there were no significant differences in the response between the two types of laser used. Based on the visual analog score, there was a significantly higher score of improvement for the side irradiated with fractional Er:YAG (2940 nm) laser. Subjectively, the patients were significantly satisfied with the results on the fractional Er: YAG than on the long pulsed Nd:YAG side. Both lasers were effective, However, the improvement in appearance of acne scars was better with fractional Er:YAG laser with fewer side effects with Long Pulsed Nd:YAG laser.

Nd:YAG laser vs IPL in inflammatory and noninflammatory acne lesion treatment

BACKGROUND

Several topical and systemic therapies are available for the treatment of acne vulgaris but are associated with several limitations, and recently, intense pulse light (IPL) and long-pulsed 1064 nm Nd: YAG laser have shown efficacy.

AIMS

The current study aimed to compare the efficacy of Nd:YAG laser and IPL in inflammatory and noninflammatory acne lesions.

PATIENTS AND METHODS

Thirty patients with inflammatory and noninflammatory facial acne were assigned randomly and equally into two groups, the Nd:YAG and IPL groups. The patients received three sessions of laser 2 weeks apart, and the clinical improvement was assessed by the reduction in the number of lesions.

RESULTS

At baseline, the two groups showed a nonsignificant difference as regards total number (P = .476), inflammatory (P = .457), and noninflammatory lesions (P = .420). The improvement in total lesions was significant in the Nd:YAG Group but nonsignificant in the IPL Group (P < .001, P = .13, respectively). Three patients (20%) in the IPL Group showed exacerbation after the first and second sessions. One month after the last session, the difference in improvement between noninflammatory and inflammatory lesions showed a significant difference in the Nd:YAG Group (P = .017) and a nonsignificant difference in the IPL Group (P = .823). Nd:YAG, compared to the IPL Group, showed a significant difference as regards the improvement score in noninflammatory lesions (P = .0099) and a nonsignificant difference in inflammatory lesions (P = .4295).

CONCLUSION

The significant improvement in noninflammatory lesions and the absence of a significant flare-up of acne as seen among patients treated with IPL make Nd:YAG a better therapeutic modality for acne.

Evaluation of subject response following treatment for pigmentation or wrinkles using a diode laser

BACKGROUND

Pulsed diode array laser systems are utilized extensively for various aesthetic indications such as removal of unwanted hair, treatment of vascular and pigmented lesions, and wrinkle reduction.

OBJECTIVE

The purpose of this study was to report and assess the experience of using a diode laser system delivering pulsed infrared laser light at the near-infrared (NIR) spectrum at wavelengths of 805 and 1060 nm.

METHODS

The study was a retrospective analysis of treatment outcomes in adult subjects treated at the clinic between January 2017 and April 2018 for wrinkles and pigmentation with a noninvasive aesthetic diode laser system. Subjects were treated at nominal wavelengths of 805 nm for pigmentation and 1060 nm for wrinkles reduction. Improvement in pigmentation and wrinkles, adverse events, and patient tolerability to treatment and satisfaction were evaluated.

RESULTS

Of 44 subjects with Fitzpatrick skin types II-IV, eight were treated for pigmentation and 36 for wrinkles. For both treatments, subjects reported tolerable pain levels. All immediate responses resolved within 48 hours post-treatment. Evaluation of treatment outcomes by two blinded evaluators demonstrated significant pigmentation clearance mean of 2.50 ± 0.15, (P < .05) in subjects treated for pigmentation, as well as significant improvement mean of 0.46 ± 0.12 (P = .005) in wrinkles in 13 subjects (41%) whose "before" and "after treatment" photographs were correctly identified by both blinded evaluators. Subjects were satisfied with the treatments.

CONCLUSIONS

Use of the Diode laser effectively resulted in improvement in pigmentation and wrinkles, while maintaining a high safety profile with limited downtime.

Efficacy of long pulse Nd:YAG laser versus fractional Er:YAG laser in the treatment of hand wrinkles

There are different modalities for hand rejuvenation. Fractional Er:YAG laser and long pulse Nd:YAG laser were introduced for treating hand wrinkles. We plan to compare fractional Er:YAG laser and long pulse Nd:YAG laser in a randomized controlled double-blind design with multiple sessions and larger sample size in comparison with previous studies. Thirty-three participants with hand wrinkles entered this study. They were randomly allocated to undergo three monthly laser treatments on each hand, one with a fractional Er:YAG laser and the other with a long pulse Nd:YAG laser. The evaluations included assessment of clinical improvement determined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of hands using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT). Moreover, potential side effects and patients' satisfaction have been documented at baseline, 1 month after each treatment, and 3 months after the final treatment session. Clinical evaluation revealed both modalities significantly reduce hand wrinkles (p value < 0.05), with no significant difference between two lasers. Mean CRRT values also decreased significantly after the laser treatment compared to those of the baseline in both laser groups. There was no serious persistent side effect after both laser treatments. Both fractional Er:YAG and long pulse Nd:YAG lasers show substantial clinical improvement of hand skin wrinkles with no serious side effects. However, combination treatment by these lasers along with the other modalities such as fat transfer could lead to better outcomes in hand rejuvenation.

TRIAL REGISTRATION

IRCT2016032020468N4.

Erbium YAG laser treatment of periorbital syringomas by using the multiple ovoid-shape ablation method

INTRODUCTION

Syringomas are benign tumours that develop predominantly in the periorbital areas of women. As periorbital syringoma is adjacent to the appendages, Erbium YAG (Er:YAG) laser treatment should be an ideal tool for its precise ablation, although its use has not previously been reported. We retrospectively analysed our new ovoid-shape Er:YAG laser ablation method for the treatment of syringoma.

MATERIALS AND METHODS

We developed an extirpation method in which multiple, 2- to 4-mm, egg-shaped ablation fields were created. This method was used to treat 49 patients, 35 of whom had predominantly accumulated syringomas, and 14 had disseminated syringomas. Treatment was repeated every 2 months.

RESULTS

Our approach was successful in both disseminated- and accumulated-type syringoma as well as plaque-type syringoma, which is considered to be the most difficult to treat. After an average of 3.77 treatments, more than 75% of the syringoma in the treated area had disappeared in 43 of 49 patients.

CONCLUSION

Our ovoid-shape ablation method gives good cosmetic results even in the most difficult type of syringoma.

Comparison of effectiveness of 1,064-nm Nd:YAG laser and Nd:YAG laser-IPL combination treatments in hand skin rejuvenation

OBJECTIVE

Evaluation of the efficacy and side effects of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and Nd:YAG laser-intense pulsed light (IPL) combination treatments in photorejuvenations of skin of the hand, and determining their impacts on patient satisfaction.

MATERIALS AND METHODS

Thirty-five female patients with signs of photoaging on the skin of their hands were included in the study. Three sessions of IPL and four sessions of Nd:YAG laser treatment were applied to the right hand in total with 2-week intervals between each session, whereas six sessions of Nd:YAG laser treatment were applied to the left hand of patients with 2-week intervals between each session.

RESULTS

The patients' ages ranged between 31 and 78, and mean age was 60.77 ± 9.48. While there was no difference in pigment distribution, fine wrinkles, coarse wrinkles, and global scores between the right and left hand prior to treatment (p > 0.05), average pigment tone score was higher in the right hand with a statistically significant difference (p < 0.05). There was greater improvement in scores of pigment distribution, fine wrinkles, sallowness, pigment tone parameters, and global score on the right hand compared to left hand, which was statistically significant (p <0.001).

CONCLUSION

In rejuvenation of photoaged dorsal skin of the hand, IPL-Nd:YAG laser combination treatment surpasses Nd:YAG laser treatment.