Nonablative skin rejuvenation devices and the role of heat shock protein 70: results of a human skin explant model

Hybrid fractional laser facial resurfacing: A comparison between a single treatment at high settings versus multiple treatments at low to moderate settings

OBJECTIVES

Fractional laser treatments for facial skin rejuvenation is an evolving field with the increase of innovative technologies. Typically, better results are achieved by using more aggressive approaches although this is accompanied by an increased risk. The demand for a modality that combines efficacy with minimal downtime and risk of adverse events led to the development of a hybrid laser, which delivers a fractional treatment of ablative CO2 and nonablative 1570 nm lasers, simultaneously. This study compares the clinical results, side effects, and downtime profile of the hybrid laser in multiple low-to-moderate-setting treatments versus a single high-setting treatment in the facial area.

MATERIALS AND METHODS

This retrospective single-center study included 44 patients who underwent 1-3 treatments with the hybrid laser for facial rejuvenation between the years 2020-2022. The patients were divided into two groups based on the number of treatments they had received (Group A; single high-setting treatment, Group B; 2-3 low-to-moderate setting treatments). Three independent nontreating physicians evaluated the objective improvement by assessing the patients' standardized clinical photographs before and after the treatments, using three different scales. Treatment data, adverse events, and patients' satisfaction in each group were also reviewed.

RESULTS

A superiority to 2-3 low-to-moderate setting treatments (Group B) was found in most of the evaluated scales. Patients' satisfaction was significantly higher in Group B, and the average downtime was significantly lower: 4.3 ± 1.6 days versus 7.3 ± 2.3 days in Group A. The expected treatment effects were significantly milder in severity in Group B as graded by the patients, and no adverse events were reported in this group. An average overall improvement of 51%-75% according to Global Esthetic Improvement Scale (GAIS) was found in both groups.

CONCLUSIONS

The new hybrid laser generates remarkable clinical outcomes in facial rejuvenation. Performing several treatments at mild to moderate settings can lead to a safer and more favorable procedure while maintaining high efficacy and achieving higher patients' satisfaction.

Postabdominoplasty Scar Improvement after a Single Session with an Automated 1210-nm Laser

Abdominoplasty, one of the most commonly performed aesthetic procedures, aims at correcting excess abdominal skin and fat, but generates a long abdominal scar. The efficacy of an automated portative 1210-nm laser in improving the appearance of surgical scars has been previously demonstrated in a double-blind randomized controlled trial. The purpose of this work was to document the use of this laser in real-life practice.

Methods

Eighteen patients undergoing abdominoplasty and treated with the evaluated laser (UrgoTouch, Laboratoires Urgo; one single session immediately after the surgery) were included in this prospective, mono-center, observational study. Change in scar characteristics was assessed using the validated Observer Scar Assessment Scale, and the patients' and surgeon's satisfaction was rated using a four-point scale.

Results

The aesthetic outcome of the scars was very positive with a mean Observer Scar Assessment Scale score of 17.0 (SD 4.6) and 14.4 (SD 3.8) on the 6-60 point scale (60: the worst possible outcome) at 6 and 12 months, respectively. A high degree of satisfaction was also expressed by both surgeon and patients at 6 weeks, 6 months, and 12 months. No laser-related incident was reported during the study, including in patients with darker phototypes.

Conclusions

These findings seem to be consistent with previous clinical evidence on the use of this laser on fresh incisions. The high degree of satisfaction reported by both surgeon and patients seems to comfort the benefits of this procedure at short- and long-term and support the use of this laser in daily practice of plastic surgery.

Early acne scar intervention with 1064 nm picosecond laser in patients receiving oral isotretinoin: a randomized split-face controlled pilot study

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.

Safety of Combined Fractional Microneedle Radiofrequency and CO2 as an Early Intervention for Inflammatory Acne and Scarring Treated With Concomitant Isotretinoin

BACKGROUND

Fractional microneedle radiofrequency (FMRF) systems are popular options for treating acne scars. However, treatment efficacy when used in combination with traditional ablative fractional laser (AFL) and the safety profile with concomitant use of isotretinoin remain unknown.

OBJECTIVE

The aim of this study was to assess the safety and efficacy of an early intervention combination treatment protocol for inflammatory acne and acne scars.

MATERIALS AND METHODS

The electronic records of 71 patients with inflammatory acne and acne scars were included in this retrospective observational study. Data were collected for all patients who received combination FMRF and AFL. Within the study group, 43 patients were receiving low-dose isotretinoin or had completed isotretinoin within the past 3 weeks.

RESULTS

The mean Scar Global Assessment score significantly decreased after 3 sessions of combination treatment (n = 71). Patients with inflammatory acne showed a significant decrease in the number of inflammatory lesions (n = 30). Patients with concomitant low-dose isotretinoin use reported a further decrease in Scar Global Assessment score (n = 43). There were no reported persistent side effects, including prolonged inflammatory reaction or scarring.

CONCLUSION

Combination treatment with FMRF and AFL is an effective and well-tolerated treatment modality for acne scars and inflammatory acne.

Update Dermatologische Lasertherapie II – Weiterentwicklung der photodynamischen Therapie durch Laser‐assistierte transkutane Applikation von Topika

Die technische Fortentwicklung der jüngeren Vergangenheit bietet dem Dermatologen Zugriff auf neue Laser, Strahlquellen und Behandlungskonzepte. Seit langem eingeführte Wellenlängen zur Ablation sind nunmehr fraktioniert applizierend verfügbar und stehen nunmehr für eine wirksamere und effizientere Behandlung von zahlreichen Hautveränderungen zur Verfügung. Das gezielte Einbringung von Topika (laser assisted drug delivery; LADD) ist das wichtigste Beispiel. Die LADD erfordert eine spezifische Weiterbildung, um sicher und wirksam zur Therapie (prä-)maligner nichtmelanozytärer Neoplasien der Haut wie der Feldkanzerisierung in Form der Laser-assistierten photodynamischen Therapie angewandt werden zu können. Bisher verfügbare Daten weisen auf eine höhere Effektivität im Vergleich zu konventionell verwendeten Topika hin, wobei anhaltend über Weiterentwicklungen berichtet wird. Unter anderem wurde die Kombination mit Tageslicht oder alternativen tageslichtähnlichen Strahlquellen bekannt. Dieses Update basiert wie zitiert gekürzt und aktualisiert auf "Paasch, U. 2019. Laser-assistierte photodynamische Therapie. p. 226-239. In G. Kautz (ed.) Energie für die Haut. Springer Nature, Springer Nature.".

Update on dermatologic laser therapy II - advances in photodynamic therapy using laser-assisted drug delivery

Technical advances in recent years have led to the development of new dermatologic laser systems, light sources, and treatment concepts. With the introduction of ablative fractional lasers (using common wavelengths) in the field of dermatology, it is now possible to more effectively and efficiently treat a variety of skin disorders. One important example of these advances is laser-assisted drug delivery (LADD). A type of LADD, laser-assisted photodynamic therapy has been successfully employed in the treatment of non-melanoma skin cancer including field cancerization. This treatment concept has been continually modified and today includes the use of daylight as well as artificial daylight systems. This update is based as cited, shortened and updated according to "Paasch,U. 2019. Laser-assistierte photodynamische Therapie. p. 226-239. In G.Kautz (ed.) Energie für die Haut. Springer Nature, Springer Nature".

Laser pretreatment for the attenuation of planned surgical scars: A randomized self-controlled hemi-scar pilot study

BACKGROUND

Nonsurgical scar attenuation options include compression garments, silicone gel, intralesional drug therapy, radiation therapy, laser, and light therapies. Laser application preceding surgical intervention has been shown to modify the wound-healing process and affect subsequent scar formation. The objective of this study was to evaluate the safety, efficacy, and final cosmesis of a single presurgical laser treatment on surgical scar formation.

METHODS

This was a randomized, controlled, intraindividual split-scar pilot study with blinded assessments of treated versus untreated planned incision sites. One half of each planned scar was treated by means of an Erbium glass, 1540 nm laser, 24 h before surgery, and the other half was not treated and served as the control. Clinical evaluations and the measurements of patient and physician POSAS scales were done at 1 and 12 months following surgery.

RESULTS

Eleven patients completed the study and were included in the analyses. Laser pretreatment showed a significant beneficial effect compared with no treatment. Both the patient and physician mean Patient and Observer Scar Assessment Scale scores were significantly lower for the laser-treated half of the scars compared with the control side (1.55 to 3.00, p = 0.02 and 2.28 to 4.42, p = 0.03). There was a highly significant interobserver correlation in the evaluation of the overall posttreatment changes (r = 0.904, p < 0.001).

CONCLUSION

A single presurgical laser treatment of a planned incision site is a simple, safe, and painless strategy to significantly improve the final scar appearance.

Early laser intervention to reduce scar formation - a systematic review

The ability of laser treatment to affect wound healing and subsequently minimize scar formation has been investigated in recent years. However, no systematic review links these clinical trials. The aim of this study was to systematically review and evaluate clinical evidence for early laser intervention to reduce scar formation in studies where laser treatment was introduced less than 3 months after wounding. We searched PubMed using relevant keywords in June 2017. Titles, abstracts and articles were sorted according to inclusion and exclusion criteria. Methodological quality was evaluated according to Cochrane Collaborations risk-of-bias assessment guideline by two independent authors. Twenty-five articles met the inclusion criteria. In total, 22 of 25 studies were controlled studies, and 17 of 25 studies compared laser treatment vs. untreated control scars. The following laser devices have been investigated: pulsed dye laser (PDL), potassium-titanyl-phosphate (KTP) laser, fractional erbium:glass 1540 nm/1550 nm, fractional/full ablation erbium-doped yttrium aluminium garnet (Er:YAG) laser or fractional CO2 laser. Eighteen studies applied laser treatments 2-4 times with 2- to 8-week intervals, while seven studies applied only one laser treatment. Follow-up time ranged from 1 to 12 months with 18 studies using a follow-up time ≤3 months. In general, laser-treated wounds and scars showed benefit from laser intervention, though not always reaching significance. Significant scar improvement was found in three of four studies using laser treatment in inflammation phase, in six of 16 studies with laser initiated in the proliferation phase and in two of five studies in the remodelling phase. High risk of bias was found in randomization and allocation concealment, and low risk of bias with regard to blinding of outcome assessment and lost to follow-up. In conclusion, laser intervention when introduced in inflammation, proliferation or remodelling phase has the potential to reduce cutaneous scar formation. Further, high-quality studies are needed before standard protocols can be implemented in clinical practice.

Preventive effect of polynucleotide on post-thyroidectomy scars: A randomized, double-blinded, controlled trial

BACKGROUND AND OBJECTIVE

Polynucleotide (PN) provides a structural scaffold to induce anti-inflammatory and enhanced wound healing properties, and this study aimed to assess the efficacy of PN administration in the prevention of post-operative scars after conventional open total thyroidectomy.

STUDY DESIGN MATERIALS AND METHODS

Forty-two patients with thyroid carcinoma who underwent total thyroidectomy were randomly assigned to the study (PN administration) or control (normal saline) group. All patients underwent a single session of combined ablative and non-ablative fractional laser. The Vancouver Scar Scale (VSS), global photographic assessment, and objective scar were assessed using three-dimensional (3D) camera at baseline and at 2, 4, 8, and 16 weeks after surgery.

RESULTS

Patients who underwent PN injection demonstrated better surgical scar quality outcome. Participants in the PN administration group had lower VSS scores than the control group (2.09 ± 0.47 vs. 4.01 ± 0.55, respectively) and lower scar height (0.23 ± 0.03 vs. 0.29 ± 0.03, respectively), as measured using 3D imaging. Furthermore, in the PN injected group, the degree of erythema, and pigmentation of the scar were less prominent. No patient developed hypertrophic scar or keloids on the surgical site. No other adverse events, including post-inflammatory hyperpigmentation, scarring, or infection, were observed.

CONCLUSION

Adjuvant administration of PN along with conventional fractional laser treatment led to more favorable effect in wound healing and post-operative scar prevention after thyroidectomy. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

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.

In vivo wound healing and dermal matrix remodelling in response to fractional CO(2) laser intervention: clinicopathological correlation in non-facial skin

PURPOSE

Ablative fractional photothermolysis is a new concept for treatment of aged skin. Despite the low frequency of side effects there are now several reports about scarring, especially in non-facial regions like the neck. Our study aimed to investigate the in vivo wound healing process and remodelling in an area prone to scarring using a fractional ablative CO(2) laser with three different energy protocols.

MATERIALS AND METHODS

Six patients with photo-damaged skin received a single fractional ablative treatment using a 250-µm scanning CO(2) laser. Three areas on the neck were treated with 50, 100 and 300 mJ/microbeam at densities of 200, 150 and 100/cm(2), respectively. Biopsies were taken from untreated skin (control) and 10 minutes, 3 days, 14 days, 21 days and 28 days post-intervention.

RESULTS

Fractional ablation with higher energies resulted in increased total thermal damage. Overall, 50 mJ was effective up to the superficial dermis, 100 mJ up to the mid-dermis, and 300 mJ resulted in deep dermal ablation. The intensity of lymphocytic inflammation and dermal remodelling correlated with the total amount of thermal damage. At 300 mJ, granuloma was present and persisted for at least 4 weeks as opposed to clinical healing, which was completed < 2 weeks.

CONCLUSIONS

With the above-mentioned low and medium parameter settings, ablative fractional photothermolysis is safe and effective in non-facial skin. However, dermal remodelling continues for up to 4 weeks, which should be the minimum space between treatment sessions. Higher energies may induce granuloma formation, possibly a sign of an overstrained remodelling capacity.

Update dermatologic laser therapy

New trends in dermatological laser therapy during the last years are based on new wavelengths, concepts and treatment combinations resulting in a variety of new dermatologic indications. Fractional laser therapy of chronic actinic damage of the skin has been introduced and already represents a standard technique. The concept of fractional non-ablative and ablative laser treatment has been shown to be safe and effective. Also pigmented and vascular skin changes can be treated by this method. New, very promising concepts for laser epilation include linear scanned as well as low fluence laser systems. The first enable very short treatment times for large areas; the latter are the basis for the growing market of laser epilation devices for home use. Nevertheless, the potential of low fluence laser devices for long-term hair reduction has not been tested so far. Furthermore, no data exist on side effects resulting from repetitive application of laser light to melanocytic lesions. Laser lipolysis has been introduced as the latest, minimally invasive way of removing small localised fat deposits. The new procedure may have a great potential for liposculpture; its further development should be thoughtfully observed. The latest innovations for precise ablation are ultra-short pulsed laser systems. Femtosecond lasers avoid thermal damage at the border areas of ablation zones.