Nonablative resurfacing has proven its efficacy in vascular and pigmented lesions, while its capacity of substantial wrinkle reduction is still discussed controversially. We present the treatment results of a 1,450 nm diode laser for facial rhytides.
Thirty facial regions were treated with a 1,450 nm diode laser. Pre- and post treatment pictures were compared by the treating physician and two blinded observers.
Even if mild improvement was rated in up to 35% of the post treatment pictures, a discrepancy shows up in the assessments of the three observers, presenting almost no congruency in the rating of improvement.
Our study failed to provide convincing data on the efficacy of nonablative treatment of rhytides with the 1,450 nm diode laser. In this respect, we challenge objective judgment in the assessment of subtle changes in nonablative wrinkle reduction.
"The present laser- and light-based ablative, nonablative and fractional skin rejuvenation techniques rely on selective photothermolysis based on linear absorption of optical energy by the skin’s constituents [1–6]. The prolonged recovery time and significant risk profile associated with the highly effective ablative techniques prompted the development of nonablative and fractional methods [3, 4]. Nonablative fractional photothermolysis creates thermal damage in the dermis without causing significant epidermal removal or injury. "
[Show abstract][Hide abstract] ABSTRACT: We demonstrate the efficacy of a novel minimally invasive nonthermal skin rejuvenation technique for wrinkle and fine-line reduction based on laser-induced optical breakdown. The optical breakdown caused by tightly focused near-infrared laser pulses creates a grid of intradermal lesions without affecting the epidermis, leading to skin rejuvenation. The pilot in vivo efficacy test performed on five subjects successfully demonstrates wrinkle and fine-line reduction, and improvement of other skin features without pain or any other unpleasant sensations or any social downtime associated with the treatment. The efficacy is evaluated objectively and subjectively by assessing the improvement of wrinkles and/or fine lines or skin texture after the treatment. The treatment is safe without side effects or social downtime, and all test subjects reported that the treatment is "perceptible but not painful." Four out of the five subjects who participated in this pilot study were assessed to have "minor" to "significant" improvements of wrinkles and fine lines by the professional panels. The results of this clinical study are expected to bring a paradigm shift in the present laser- and light-based skin rejuvenation methods by introducing a safe treatment procedure without damaging the epidermis, with no or little social downtime and with an efficacy that might be comparable to ablative techniques.
Lasers in Medical Science 08/2012; 28(3). DOI:10.1007/s10103-012-1179-z · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate efficacy and adverse effects of intense pulsed light rejuvenation in a homogeneous group of patients.
Randomized controlled split-face trial.
University dermatology department.
Thirty-two female volunteers with Fitzpatrick skin type I through III and class I or II rhytids.
Subjects were randomized to 3 intense pulsed light treatments at 1-month intervals or to no treatment of right or left sides of the face.
Primary end points were skin texture and rhytids. Secondary end points were telangiectasia, irregular pigmentation, and adverse effects. Efficacy was evaluated by patient self-assessments and by blinded clinical and photographic evaluations up to 9 months after final treatment. Adverse effects were assessed clinically and by noninvasive skin reflectance measurements.
Skin texture was significantly improved at all clinical assessments except at the 6-month examination (P<.006). The improvements peaked at 1 month after treatment, at which time 23 (82%) of 28 patients had better appearances of treated vs untreated sides. Most patients obtained mild or moderate improvements, and 16 patients (58%) self-reported mild or moderate efficacy on skin texture. Rhytids were not significantly different on treated vs untreated sides, and 19 patients (68%) reported uncertain or no efficacy on rhytids. Significant improvements of telangiectasia (P<.001) and irregular pigmentation (P<.03) were found at all assessments. Three patients withdrew from the study because of pain related to treatment.
Three intense pulsed light treatments improved skin texture, telangiectasia, and irregular pigmentation but had no efficacy on rhytids. Adverse events were minimal, but included scar in 1 patient.
Archives of Dermatology 08/2006; 142(8):985-90. DOI:10.1001/archderm.142.8.985 · 4.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fractional photothermolysis is a new concept in cutaneous re-modeling whereby laser-induced microscopic zones of thermal injury (MTZ-Microscopic Treatment Zones) are surrounded by normal, viable tissue. This unique thermal damage pattern allows re-epithelialization in less than 24 hours. To increase patient comfort level during the procedure of fractional photothermolysis, simultaneous skin cooling has been proposed and is now extensively used. The purpose of this in vitro study was to examine the influence of skin temperature on the diameter of the epidermal microthermal zone and the extent of thermal injury per unit area. The determination of the changes in these parameters that are due to skin temperature will allow the better control and understanding of fractional photothermolysis at different skin temperatures.
Fractional photothermolysis was performed with a 1,550 nm fiber laser (Fraxel SR Laser) with 10 mJ per pulse on full-thickness cadaver skin. The skin samples were brought prior to exposure to temperatures that ranged from 0 to 45 degrees C. The epidermis of the skin samples was separated by dispase treatment, stained for thermal damage by NBTC stain, and lesion diameter was assessed by a blinded investigator.
The average MTZ diameter exhibits a positive, linear relationship with skin temperature (R(2) = 0.904, P < 0.0001). As the skin temperature increases from 0 to 45 degrees C. The MTZ diameter increases from 93 to 147 microm (58%), and the MTZ area from 6,870 to 17,050 microm(2) (148%).
The skin temperature affects the size of epidermal MTZs during fractional photothermolysis and is an important variable factor. The use of simultaneous skin cooling increases patient comfort; however, as it also decreases MTZ size, it may interfere with treatment efficacy. The control of skin temperature is necessary to provide a consistent outcome and to be able to compare treatments.
Lasers in Surgery and Medicine 01/2007; 39(1):14-8. DOI:10.1002/lsm.20453 · 2.62 Impact Factor
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