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Photorejuvenation: Concepts, Practice, Perspectives
Abstract
Photorejuvenation is an all-purpose term that can be appealing to patients looking for finest results with negligible downtime, enticed by the alleged healing potential of lasers and high energy light technologies.
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Background
While skin aging is triggered by multiple factors and typically presents with multiple manifestations, conventional treatment regimens deploy a single treatment modality. Typical approaches exploit ablative techniques, which involve considerable patient discomfort and downtime and can induce adverse events. Non‐ablative fractionated laser (NAFL) resurfacing promotes neocollagenesis, with significantly fewer complications and discomfort. At the same time, intense pulsed light (IPL) therapies have a marked impact on skin tone, with an effect on collagen deposition. This study evaluated the combined effect of same‐day, sequential IPL‐NAFL treatment on photoaging of the face.
Design
In this prospective study, 30 patients presenting Fitzpatrick skin types II–IV, elastosis scores 3–6 and mild to moderate pigmentation, underwent three sessions, of full‐face IPL therapy, followed immediately by NAFL treatment, conducted at 4–6 weeks intervals. Wrinkle/elastosis and skin qualities were scored at 1, 3, and 6 months after the last treatment session. Immediate responses were evaluated up to 30 min following treatment and adverse events were monitored throughout the study period.
Results
Wrinkle/elastosis scores gradually improved over the treatment period, with 59% of patients presenting a ≥1‐point improvement in FES scores by the 1‐month follow‐up session, which persisted also at the 6 months follow‐up visit. Good to excellent pigmentation responses were recorded for ≥63% and improvements in texture, brightness, and tightness were recorded for ≥80% of patients throughout the follow‐up period. Over 90% of the treated patients exhibited improved or much improved overall appearance. Patient scorings and satisfaction level reflected physician assessments. Treatments were well tolerated and the social downtime observed was of 1.5 ± 0.25 days.
Conclusion
The same‐day combined IPL‐NAFL regimen proved safe and elicited a significant skin rejuvenating effect, in a similar manner to that shown in other same‐day combined therapies, without prolonging downtime of each individual modality. Lasers Surg. Med. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
Solar lentigines are common pigmentary lesions. Q-switched lasers are effective treatment options but postinflammatory hyperpigmentation (PIH) is common in darker skin. The objective of the study is to compare the efficacy and safety in solar lentigines of Asian skin treated by Q-switched potassium titanyl phosphate (KTP) 532-nm nanosecond laser vs. KTP 532-nm picosecond laser for the treatment of solar lentigines in Asians. Thirty patients with at least 2 solar lentigines on the upper extremities were enrolled. A total of 30 paired lentiginous lesions were randomly treated with a single treatment of either Q-switched KTP 532-nm nanosecond laser vs. KTP 532-nm picosecond laser. In terms of efficacy, mean luminance score was evaluated at baseline, at 6th, and 12th week. Degree of pigment clearance was assessed by a blinded physician and the patients. Satisfaction score was rated by patients using visual analogue scale. Adverse events were also recorded. Twenty-eight patients completed the study. Both lasers showed significant improvement in mean luminance score from baseline (p < 0.05). Likewise, there was no significant difference in pigment clearance between two lasers either assessed by physician or patients. However, patients’ satisfaction score was significantly higher with the picosecond laser (p = 0.014). Adverse events and pain were not different between groups. Q-switched KTP 532-nm nanosecond laser and KTP 532-nm picosecond laser are safe and effective for treating solar lentigines in Asians. Based on cost-effectiveness, Q-switched KTP 532-nm nanosecond laser remains the main treatment while KTP 532-nm picosecond laser can be considered as a treatment option.
Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.
The objective of this study was to evaluate the efficacy and safety of using a 694-nm fractional Q-switched ruby laser to treat infraorbital dark circles. Thirty women with infraorbital dark circles (predominant color: dark/brown) participated in this open-labeled study. The participants received eight sessions of 694-nm fractional Q-switched ruby laser treatment using a fluence of 3.0–3.5 J/cm2, at an interval of 7 days. The melanin deposition in the lesional skin was observed in vivo using reflectance confocal microscopy (RCM). The morphological changes were evaluated using a global evaluation, an overall self-assessment, and a Mexameter. Twenty-eight of the 30 patients showed global improvements that they rated as excellent or good. Twenty-six patients rated their overall satisfaction as excellent or good. The melanin index indicated a substantial decrease from 240.44 (baseline) to 194.56 (P < 0.05). The RCM results showed a dramatic decrease in melanin deposition in the upper dermis. The adverse effects were minimal. The characteristic finding of dark/brown infraorbital dark circles is caused by increased melanin deposition in the upper dermis. The treatment of these infraorbital dark circles using a 694-nm fractional QSR laser is safe and effective.
Laser treatment of vascular lesions is affected by parameters including the diameter and depth of the vessels and flow within the vessels. Topical anaesthetics are in common use prior to laser treatment but may have effects on vessel parameters and, subsequently, the efficacy of laser treatment. Eleven patients with capillary vascular malformations were investigated for vessel diameter before and after elective application of a topical anaesthetic, Eutectic Mixture of Local Anaesthetics (EMLA) (AstraZeneca) or Ametop (S&N Health), prior to pulsed dye laser treatment. EMLA contains 2.5 % lidocaine ad 2.5 % prilocaine, and Ametop gel contains 4 % tetracaine. Patients' capillary malformations were assessed using confocal laser scanning microscopy (CLSM) (Vivascope 1500 Mavig GmbH, Munich). Six of the 11 patients recruited had EMLA topical anaesthetic, and five had Ametop. Four hundred twenty-one diameters were measured. The mean vessel diameter was 50.87 μm. Previous laser treatments undergone by each patient were noted to exclude this as a confounding variable, and no significant difference was found between topical anaesthetic groups. Statistical calculations were made using GenStat and Minitab. There is no evidence that Ametop affects mean diameter (p value is 0.361). EMLA reduces the mean diameter of vessels (p = 0.002), with a 27 % reduction in post-EMLA diameter. This study demonstrates that the use of EMLA cream has a statistically significant reduction vessel diameter. As it is known that vessel diameter is important for the response of laser treatment, the use of EMLA may affect outcome.
Background and objectives:
Solar lentigines are commonly found in sun-exposed areas of the body including hands, neck, or face. This study evaluates the efficacy of an intense pulsed light (IPL) device, with wavelengths between 500 and 635 nm and delivered with a targeted tip, for the treatment of solar lentigines on Japanese skin.
Study design/materials and methods:
Forty Japanese patients with solar lentigines received one IPL treatment with a targeted treatment tip that emits wavelengths between 500 and 635 nm and contact cooling. Pulses were delivered through a targeted tip to each lentigo until mild swelling and a gray color were observed. Digital photographs and gray level histogram values were taken pre- and post-treatment, and patient assessments were recorded post-treatment.
Results:
Significant improvement was observed for all patients in digital photographs and mean values of gray level histograms (P < 0.0001). Ninety percent of patients reported satisfaction with the improvement of the treatment area and convenience of the procedure. Complications were minor and transitory, consisting of a slight burning sensation and mild erythema which resolved within 5 hours of treatment. No serious adverse events were observed.
Conclusions:
A short-wavelength IPL, delivered with a targeted tip and contact cooling, offers a highly efficacious treatment for solar lentigines in Japanese skin with minimal downtime and complications. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc.
Melasma is a common hypermelanosis of the face. The use of a classical Q-switched ruby laser (QSRL) to treat melasma is discussed controversially and is associated with frequent adverse effects, such as hyper- or hypopigmentation. Recently a fractional-mode (FRx) QSRL was developed to minimize the adverse effects of classical QSRL. The objective of this research was to evaluate the efficacy and safety of a novel FRx-QSRL in the treatment of melasma in Caucasian patients.
We performed a retrospective study of 25 Caucasian melasma patients (Fitzpatrick skin types I to III). Patients received one to three FRx-QSRL treatments (Tattoostar FRx, Asclepion Laser Technologies, Jena, Germany) at pulse energies of 4 to 8 J/cm2. Three blinded investigators independently evaluated the melasma area and severity index (MASI) score before treatment and at the four- to six-week follow-ups. At additional three-month follow-ups, patients evaluated subjective improvement, pain and over-all satisfaction with the treatment according to a numeric analogue score (NAS). Side effects were documented.
At four to six weeks post laser treatment for a mean of 1.4 sessions, we observed a significant (P = 0.0001) reduction of the MASI score from 6.54 to 1.98 (72.3%). Patients rated the pain of the intervention at a mean 2.46 points (0 = no pain; 10 = maximum pain), the improvement at a mean 5.55 points (0 = no improvement; 10 = maximum improvement) and the overall satisfaction at a mean 4.66 points (0 = not satisfied; 10 = maximum satisfaction). After three months, post-inflammatory hyperpigmentation (PIH) and/or recurring melasma were observed in 7 (28%) and 11 (44%) patients, respectively.
The 694-nm FRx-QSRL is a safe and effective option for treating melasma in Caucasian patients. Over periods of >3 months, PIH and/or recurring melasma may develop at significant rates and may reduce patient satisfaction. Multiple treatment sessions with lower pulse energies and/or a post-interventional therapy with hypopigmenting ointments and UV protection may help to minimize these complications.
Background and aims:
A variety of treatment modalities have been used to reduce the size of en-larged pores. The 1064 nm Nd:YAG laser, in addition to its role in removal of tattoos and age-related dyschromia, depilation and skin rejuvenation, may also play a role in reducing the size of enlarged pores. The present split-face controlled study assessed and compared the efficacy between the quasi long-pulsed (micropulsed) and the Q-switched modes of the Nd:YAG laser in the treatment of enlarged pores.
Subjects and methods:
Twenty subjects with enlarged pores were recruited for the micropulsed vs Q-switched study, all treated with the same 1064 nm Nd:YAG laser system. Ten subjects were treated with the 300 µs micropulsed mode and the other ten subjects were treated with the 5 ns Q-switched mode. All subjects were treated on the right half of the face, the left half serving as an untreated control. Five laser sessions were performed. The pore sizes were measured using an image analysis program and the sebum level was measured with a Sebumeter(®) before and after the treatments.
Results:
The pore size and sebum level significantly decreased with treatment on the treated side (right cheek and right half of nose) in both the micropulsed and Q-switched modes compared to the control side (p<0.05), but without any statistically significant difference between the modes.
Conclusions:
The micropulsed and Q-switched Nd:YAG laser treatments reduced pore size and sebum levels with more or less equal efficacy and with no adverse side effects.
Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Although skin is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse signaling pathways are activated. Stem cells can be activated, allowing increased tissue repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting autoimmunity. Inflammatory diseases such as psoriasis and acne can also be managed. The noninvasive nature and almost complete absence of side effects encourage further testing in dermatology.
The aim of this study was to determine the effects of intense pulsed light (IPL) on cell proliferation and the secretion of vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) in human fibroblasts and vascular endothelial cell lines, and to investigate the effects of IPL on the mRNA expression levels of type I and III procollagens in cultured human fibroblasts. Foreskin fibroblasts and a vascular endothelial cell line (ECV034) were cultured and treated with various wavelengths and doses of IPL irradiation. After culture for 1, 12, 24 and 48 h following IPL irradiation, fibroblasts and the vascular endothelial cell line were harvested for investigation of morphological changes by light microscopy, cell proliferation viability by MTT assay, and VEGF and MMP secretions by ELISA. The mRNA expression levels of type I and III procollagens in the fibroblasts were detected by RT-PCR. No marked morphological changes were observed in the cultured fibroblasts compared with the control. Cell growth and cellular viability were increased in fibroblasts 24 and 48 h after IPL irradiation. The levels of type I and III procollagen mRNA expression in fibroblasts increased in a time-dependent manner. However, the IPL management had no impact on VEGF and MMP secretion levels in fibroblasts and the ECV034 cell line at any time-point after irradiation as well as cell morphology and cellular proliferation. IPL irradiation may induce cellular proliferation and promote the expression of procollagen mRNAs directly in cultured primary fibroblasts, which may primarily contribute to photorejuvenation.
Background:
Q-switched laser treatment for pigment disorders commonly leads to postinflammatory hyperpigmentation (PIH) in Asians.
Objectives:
To evaluate the effect of spot size and fluence on Q-switched alexandrite laser (QSAL) treatment for pigmentation in Asians.
Methods:
Ten patients with freckles, 18 with lentigines, and 8 with acquired bilateral nevus of Ota-like macules (ABNOM) received 1 session of QSAL treatment for a 3-mm spot on one cheek and a 4-mm spot on the other cheek. The lowest fluences to achieve a visible biologic effect were chosen.
Results:
The patients with freckles experienced the highest improvement rate (83-84%), followed by those with lentigines (52%) and ABNOM (35%). Similar efficacy was observed for both cheeks (p > 0.05). PIH developed in 10% (1/10), 44% (8/18), and 75% (6/8) of the patients with freckles, lentigines, and ABNOM, respectively. The severity of PIH was lower in the 4-mm spot with a lower fluence than in the 3-mm spot with a higher fluence in patients with lentigines (p = 0.03), but not in those with freckles or ABNOM.
Conclusions:
Using a larger spot to achieve the same biologic effect at a lower fluence is associated with equal efficacy and less-severe PIH in patients with lentigines.
Long-pulse and Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) 1,064-nm laser used for facial rejuvenation can improve pore size. Topical carbon has been used to enhance efficacy.
To compare the efficacy and safety of a 1,064-nm long-pulse Nd:YAG laser alone with that of a combination Q-switched Nd:YAG laser with topical carbon lotion followed by long-pulse Nd:YAG to improve enlarged pores.
Twenty Thai women randomly received five treatments with a long-pulse Nd:YAG laser on one facial half (LP side) and long-pulse Nd:YAG after carbon-assisted Q-switched Nd:YAG laser on the contralateral side (carbon QS+LP side) at 2-week intervals. Participants were evaluated using digital photography, complexion analysis, and a chromometer.
There was significant decrease in pore counts of 35.5% and 33% from baseline on the carbon QS+LP and LP sides, respectively. Physician-evaluated pore size improvement was 67% on the carbon QS+LP sides and 60% on the LP sides. Chromometer measurement showed an increase in skin lightness index. There was no significant difference between the two treatments, although there were more adverse effects on the carbon QS+LP side.
Long-pulse Nd:YAG 1,064-nm laser improves the appearance of facial pores and skin color. Adding carbon-assisted Q-switched Nd:YAG did not enhance the results but produced more side effects.
Limited studies have reported the in vivo reflectance confocal microscopy (RCM) features of lentigo maligna (LM). A total of 64 RCM features were scored retrospectively and blinded to diagnosis in a consecutive series of RCM sampled, clinically equivocal, macules of the face (n=81 LM, n=203 benign macules (BMs)). In addition to describing RCM diagnostic features for LM (univariate), an algorithm was developed (LM score) to distinguish LM from BM. This comprised two major features each scoring +2 points (nonedged papillae and round large pagetoid cells > 20 microm), and four minor features; three scored +1 point each (three or more atypical cells at the dermoepidermal junction in five 0.5 x 0.5 mm(2) fields, follicular localization of atypical cells, and nucleated cells within the dermal papillae), and one (negative) feature scored -1 point (a broadened honeycomb pattern). A LM score of > or = 2 resulted in a sensitivity of 85% and specificity of 76% for the diagnosis of LM (odds ratio (OR) for LM 18.6; 95% confidence interval: 9.3-37.1). The algorithm was equally effective in the diagnosis of amelanotic lesions and showed good interobserver reproducibility (87%). In a test set of 29 LMs and 44 BMs, the OR for LM was 60.7 (confidence interval: 11.9-309) (93% sensitivity, 82% specificity).
Background
In the recent past, long pulsed dye lasers (LPDL) have been investigated for the treatment of epidermal pigmented lesions (EPLs). Using a pigmented lesion compression headpiece, blood is pushed laterally out of the laser field focusing laser energy on melanin. Recent studies have demonstrated excellent responses using a single‐pulse at the following settings: 9–12 J/cm², 1.5 milliseconds, 7‐10 mm spot size with compression. However, the majority of these studies report patients requiring up to four treatments for lesion resolution. Herein, we describe our experiences utilizing a back‐to‐back double‐pulse technique to decrease the total number of treatments needed for EPL clearance.
Methods
Thirty‐six patients (27 females, 9 males; skin types I–IV) with benign facial EPLs were included. Each lesion received two back‐to‐back pulses (fluence of 9–12 J/cm², 1.5 milliseconds duration, and 7 mm spot size). If needed, a second treatment was delivered 4–8 weeks later. Pre‐ and post‐photos after the first treatment were evaluated by two independent board‐certified dermatologists.
Results
Lesion clearance after the first treatment was graded on a Likert scale as: 1 = poor (<25% clearance); 2 = fair (25–50%); 3 = good (51–75%); and 4 = excellent (>75%). Of the 36 participants, 23 had excellent clearing, 10 with good, 2 with fair and 1 with poor clearance. There was only one case of post‐inflammatory hyperpigmentation that subsequently resolved, and no cases or scarring or hypopigmentation.
Conclusion
LPDL with compression continues to be a safe and effective modality for treatment of EPLs. Double‐pulsing decreases the total number of treatments needed for lesion resolution, while maintaining safety and potentially decreasing cost. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
Background:
Lasers and noncoherent intense pulse light sources effectively treat vascular lesions. Intense pulsed light (IPL), a nonablative treatment for photorejuvenation, uses a flashlamp which emits noncoherent light between 400 and 1400 nm. The light may be filtered to target a specific chromophore. The pulsed dye laser (PDL), at 595 nm, has been the historical standard of care in the treatment of facial erythema. We sought to determine whether IPL may be used in lieu of PDL in reducing facial erythema.
Objectives:
To determine whether IPL may be used to treat facial erythema with equal efficacy as PDL used at nonpurpuric settings.
Methods:
Prospective investigation of a cohort of 15 subjects with unwanted bilateral facial erythema. Subjects presented for two treatments with an IPL (BBL™ BroadBand Light; Sciton, Palo Alto, CA) to one half of the face and PDL (Cynergy™; Cynosure, Westford, MA) to the other half.
Results:
Patients with facial erythema may be successfully treated with IPL or PDL.
Conclusions:
Intense pulsed light and pulsed dye laser with nonpurpuric settings were equally effective in reducing facial erythema.
Recent appreciation of the multifactorial pathophysiology of skin aging has led to increased use of parallel treatment regimens. This prospective, split-face, randomized study assessed the safety and efficacy of same-day sequential Q-switched Nd:YAG laser and 1565 nm non-ablative fractional laser (SST) facial rejuvenation treatment in comparison to fractional non-ablative laser (NAFL) treatment only. Seventeen patients underwent three treatment sessions, conducted at 4-6-week intervals, in which SST treatment was delivered on a randomly selected side of the face followed by NAFL treatment on the contralateral side immediately thereafter. Immediate skin responses were assessed within 30 minutes of treatment, while wrinkle/elastosis scores, and skin tone and texture were evaluated 1, 3, and 6 months following the final treatment session. While SST and NAFL proved equally safe, SST was associated with signi cantly lower pain scores in all three treatment sessions. Both treatment regimens yielded signi cant improvements in wrinkle/elastosis scores, which were maintained throughout the 6 months of follow up. Physician-evaluated skin tone and patient ratings of skin texture and overall improvement of the SST-treated side were consistently higher than the contralateral NAFL-treated side. Histological analysis suggested a broader effect, alongside sparing of the outermost epidermal layer with the SST versus NAFL treatment. Although the SST regimen failed to demonstrate statistically signi cant clinical superiority over the NAFL regimen, the significantly lower pain levels, consistently higher physician and patient ratings following SST may justify its regular use as a skin rejuvenation technique. J Drugs Dermatol. 2016;15(11):1335-1342. .
BACKGROUND AND OBJECTIVES: In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines.
MATERIALS AND METHODS: Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm² with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm², a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment.
RESULTS: In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%.
CONCLUSIONS: The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.
Background/Objective
Solar lentigines are benign pigmented lesions that occur mostly on sun-exposed areas. Q-switched and ablative lasers are effective for removing these lesions but the high incidence of postinflammatory hyperpigmentation raises concern in darker skin types. The objective of this study is to compare the efficacy and degree of postinflammatory hyperpigmentation with the Q-switched Nd:YAG and fractional carbon dioxide (CO2) laser for treatment of solar lentigines in Asians. Study designTwenty-five Thai patients (skin phototype III-IV) with at least two lesions of solar lentigines on upper extremities were enrolled in this study. Two lesions were randomly selected for the treatment with a single session of Q-switched Nd:YAG or fractional CO2 laser. Outcomes were evaluated using physician grading scale, colorimeter, and patient self-assessment at 6 and 12 weeks after treatment. Side effects were recorded. ResultsA total of 532nm Q-switched Nd:YAG laser showed significant improvement of pigmentation over fractional CO2 laser at 6th and 12th week by both colorimeter assessment and physician grading scale (P<0.05). No significant difference in postinflammatory hyperpigmentation from both lasers was observed. In terms of patient self-assessment, 80% of the patients treated with 532nm Q-switched Nd:YAG laser had excellent results compared to 8% in fractional CO2 laser group. However, fractional CO2 laser treatment had faster healing time and less pain score compared to Q-switched Nd:YAG laser. ConclusionsQ-switched Nd:YAG is superior to fractional CO2 laser for treatment of solar lentigines but requires longer healing time and produces more pain. The incidence of postinflammatory hyperpigmentation was not significantly different with both lasers. Further studies are needed to obtain the proper parameter and the treatment frequency of fractional CO2 laser in solar lentigines. Lasers Surg. Med. 48:354-359, 2016. (c) 2016 Wiley Periodicals, Inc.
background . Unintended thermal damage occurring during surgery with the CO 2 laser limits its usefulness because of slow healing and increased scarring. The superpulsed mode was developed to address this problem, but little clinical data exist to evaluate its effectiveness.
objective . Patients having warts of the hands and feet, seborrheic keratoses, lentigines, and actinic cheilitis were treated by three experienced laser surgeons using both the conventional continuous mode CO 2 laser and a superpulsed CO 2 laser. Effectiveness of therapy, healing time, and rates of scarring were compared for the two groups of patients.
methods . Charts of patients treated in 1988 and 1989 were reviewed and data recorded regarding surgical parameters, healing time, scarring, and effectiveness of therapy. Patients were placed in a diagnosis category with each laser only if there was a corresponding patient treated by the same physician using the other laser.
conclusion . The superpulsed mode was found to convey only a slight advantage. The use of a 50‐millisecond pulse was even more advantageous. The superpulse parameters are analyzed and ideal parameters to prevent unwanted thermal damage are suggested.
Objective:
The purpose of this study was to compare degrees of epidermal/dermal tissue damage quantitatively and histologically after laser irradiation, to find ideal treatment conditions with relatively high fluence for skin rejuvenation.
Background data:
A number of recent studies have evaluated the clinical efficacy and safety of therapeutic lasers under relatively low fluence conditions.
Methods:
We transmitted the long-pulsed 1064 nm Nd:YAG and 755 nm Alexandrite lasers into pig skin according to different fluences and spot diameters, and estimated epidermal/dermal temperatures. Pig skin specimens were stained with hematoxylin and eosin for histological assessments. The fluence conditions comprised 26, 30, and 36 J/cm2, and the spot diameter conditions were 5, 8, and 10 mm. Pulse duration was 30 ms for all experiments.
Results:
Both lasers produced reliable thermal damage on the dermis without any serious epidermal injuries, under relatively high fluence conditions. The 1064 nm laser provided more active fibrous formations than the 755 nm laser, while higher risks for tissue damages simultaneously occurred.
Conclusions:
The ideal treatment conditions for skin rejuvenation were 8 mm diameter with 30 J/cm2 and 10 mm diameter with 26 J/cm2 for the 1064 nm laser, and 8 mm diameter with 36 J/cm2 and 10 mm diameter with 26 J/cm2 for the 755 nm laser.
Background:
Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources.
Objectives:
We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians.
Patient and methods:
This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients' satisfaction and preference in treatment were also assessed.
Results:
Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110).
Conclusion:
While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.
Introduction:
The Q-switched 1064-nm laser is associated with rapid vaporization and thermal expansion stresses leading to skin mechanical damage and is typically used for correction of exogenous and endogenous deep pigmentation. Giving the common place of fractional, infrared-domain milliseconds non-ablative lasers in aesthetic dermatology, a novel non-ablative fractional Q-switched 1,064-nm laser was studied for photoaged skin concerns.
Materials and methods:
Ten healthy female subjects (Age range: 35-53 years, mean: 44.3) and skin types I-IV were diagnosed with mild-to-moderate facial photo-damage, hyper-pigmentation, telangiectasia, laxity, skin roughness, and actinic keratosis. Subjects were treated with a new non-ablative fractional Q-Switched 1,064-nm Nd: YAG laser (Harmony XL, Alma Lasers Ltd.). Treatments consisted of four sessions at 2-4 week intervals. Follow-up (FU) visits were 1 and 3 months following the final treatment.
Results:
Utilizing the Glogau scale, six Subjects were graded Type II (means wrinkles in motion), and four Subjects were graded Type III (means wrinkles at rest) at Baseline. At the FU2, 3-month post final treatment, 60% of the subjects were graded with at least a one-point improvement in the overall Glogau global assessment. Between baseline and FU2, Investigator assessments showed the following improvements: Hyperpigmentation 70%, Telangiectasias 80%, Laxity 80%, Tactile Roughness 60%, and actinic keratoses 60%. Pain assessment was reported between 0 and 2 in all treatments (scale 0-10). Of expected side effects, erythema was most common, occasionally being reported as high as a 2(scale 0-10). No unexpected adverse effects were reported.
Conclusion:
The non-ablative fractional Q-Switched 1,064-nm Nd: YAG laser is safe and effective in improving signs of mild-to-moderate photodamage skin irregularities with no downtime, no pain to only minimal pain, and without any adverse side effects.
Background and aims:
Enlarged facial pores remain one of the major cosmetic concerns among Asian females. This study attempted to assess and compare the efficacy of a combination of the Q-switched and quasi long-pulsed (micropulsed) Nd:YAG laser to reduce the size of the enlarged pores with and without an exogenous photoenhancer.
Methods:
In twenty five female subjects mean age 34.04 yr and skin type II-IV, a carbon lotion as a photoenhancer was applied on one side of the face (Method 1) and the other side was used as the control (Method 2). The entire face was then treated with a single pass of the 1064 nm Nd:YAG laser in the micropulsed mode, pulse fluence and width of 2.3 J/cm(2) and 300 µsec, respectively. Multiple passes were then delivered in the Q-switched mode (2.5 J/cm(2) and 5 nsec).
Results:
Three weeks after the final treatment, 75% of the subjects showed improvement with method 1 whereas 67% showed improvement with method 2. No adverse side effects were reported with either method.
Conclusions:
Although histological confirmation was not performed, we were able to prove both subjectively and objectively that the use of the combination of the micropulsed and Q-switched modes of the Nd:YAG laser was useful in reducing pore size, and that the photoenhancer improved the efficacy.
Hintergrund: Zur Behandlung vaskulärer Malformationen und Pigmentstörungen werden zwei neue gepulste Lasertypen eingesetzt, der gepulste Farbstofflaser und der gütegeschaltete Rubinlaser. Eine Ergänzung zum gepulsten Farbstoff laser ist das Photoderm VL, eine Blitzlampe mit inkohärentem Licht und variablem Wellenlängenspektrum. Patienten und Methode: Bei über 1000 unserer Patienten wurden unterschiedliche Läsionen an Gesicht und Hals therapiert. Durch den gütegeschalteten Rubinlaser (694 nm, 25 ns) werden Lentigines benignae, Epheliden, Cafe-au-lait-Flecken, Nävi Ota, seborrhoische Keratosen sowie Laien-, Profi- und Schmutztätowierungen behandelt. Der gepulste Farbstofflaser (585 nm, 0,3-0,45ms) ist in der Therapie von Nävi flammei, Hämangiomen, essentiellen Teleangiektasien, Xanthelasmen, Keloiden und Morbus Pringle einsetzbar. Darüber hinaus werden die Einsatzgebiete des Photoderm VL (515-1200nm. 0,5ms-20ms) im Gesichts- und Halsbereich, Nävus flammeus, benigne hämangiomatöse Malformationen, Teleangiektasien, Erythrosis interfollicularis colli, Keloide und Hypertrichose, vorgestellt. Ergebnisse und Folgerungen: In der Therapie von andersartig nicht oder nur schwierig zu behandelnden Hautveränderungen im Gesichts- und Halsbereich konnten wir durch die genannten Lasertypen vielversprechende Behandlungserfolge erzielen. Gütegeschalteter Rubinlaser, gepulster Farbstofflaser und Photoderm VL bieten daher ungeahnte therapeutische Möglichkeiten, verbunden mit sehr geringen Risiken.
Summary
Background: Two new types of lasers, the pulsed dye laser and the Q-switched ruby laser, have shown good to excellent results in the treatment of vascular malformations and benign pigmented lesions of the skin. A new and very effective alternative to the pulsed dye laser is the recently introduced Photoderm VL. This device is based on the use of a wide-band non-coherent intense pulsed light source which emits a continuous spectrum in the range of 515 nm to 1200 nm. Patients and Methods: More than a 1000 patients with a variety of lesions of the skin were treated by these new laser systems and the Photoderm VL. The Q-switched ruby laser (wavelength 694 nm, pulse duration 25 ns) is suitable for the treatment of benign lentigines, ephelides, café-au-lait macules, seborrhoic ceratosis, tattoos, and traumatic tattoos. The pulsed dye laser (585 nm, 0,3-0,45 ms) treats nevi flammei, capillary hemangiomas, telangiectasias, Xanthelasma, hypertrophic scarring, and adenoma sebaceum. In addition we present the facilities of the new Photoderm VL (515nm-1200nm, 0,5-20 ms) for the treatment of nevi flammei, benign hemangiomatous alformations, telangiectasias, erythrosis interfollicularis colli, hypertrophic scarring, and hypertrichosis. Results and Conclusions: The Q-switched ruby laser, the pulsed dye laser, and the Photoderm VL show excellent results in the treatment of lesions of the skin, which otherwise would have been difficult to treat or untreatable. The efficiency of the laser types presented is based on the theory of selective photothermolysis. Scarring is almost never seen and hypo- or hyperpigmentation is in most cases transient.
Background:
Facial erythema is a common symptom that responds to vascular laser treatment, but there are few comparative studies.
Objective:
We sought to compare the effectiveness of microsecond 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with nonpurpuragenic 595-nm pulsed dye laser (PDL) for diffuse facial erythema.
Methods:
This was a split-face, double-blind randomized controlled trial. Bilateral cheeks received 4 treatments each at one month intervals with PDL or Nd:YAG. Spectrophotometer measurements, digital photographs, pain scores, and patient preferences were recorded.
Results:
Sixteen patients enrolled and 2 dropped out. Fourteen patients, all skin types I to III, 57% women, mean age 42 years, completed the study and were analyzed. Spectrophotometer readings changed after both PDL (8.9%) and Nd:YAG (2.5%), but varied by treatment type, with PDL reducing facial redness 6.4% more from baseline than Nd:YAG (P = .0199; 95% confidence interval -11.6 to -1.2). Pain varied (P = .0028), with Nd:YAG associated with less pain, at 3.07, than PDL at 3.87. Subjects rated redness as improved by 52% as a result of PDL, and 34% as a result of Nd:YAG (P = .031; 95% confidence interval -34.6 to -1.94). No serious adverse events were observed.
Limitations:
Lasers settings are not standardized across devices.
Conclusion:
Facial erythema is safely and effectively treated with PDL and Nd:YAG. Nonpupuragenic PDL may be more effective for lighter-skinned patients, but microsecond Nd:YAG may be less painful.
Background and objective:
A variety of laser and IPL treatments with continued progress have been applied for nonablative skin rejuvenation; however, the complete understanding of working mechanisms and clinical appliance strategy is not clear.
Materials and methods:
The rats were divided into three groups and irradiated with Q-switched 1064 nm Nd:YAG laser and IPL. Image analysis, chemical colorimetry method, and real-time PCR (RT-PCR) were used to detect the dermal thickness, hydroxyproline, and the expression of III procollagen mRNA, respectively, at sequential time points following irradiation. In addition, the ultra-structure changes of rat skin were observed by TEM at 3 weeks after irradiation.
Results:
Two-light treatment contributed to increase in the dermal thickness, the hydroxyproline contents and the expression of III procollagen mRNA, and the dense arrangement of collagen. The effect of collagen synthesis and remodeling could last for at least 3 months after treatment, and the YAG group is more efficient than the IPL group. The expressions of procollagen type III mRNA reached peak level at 2 weeks.
Conclusion:
The effect of different lights depends on the wavelength and the penetrated depth; the best referential treatment interval of two kinds of lights for nonablative skin rejuvenation on rat skin is 2 weeks.
Background:
To evaluate the efficacy of a novel long-pulse alexandrite laser with contact cooling in the treatment of benign pigmented lesions.
Methods:
Five patients were enrolled in the study. All patients presented with epidermal pigmented lesions on the arms, hands, chest, or legs. Patients were all female with a mean age of 59 years. At the initial evaluation, baseline pigment readings were determined with a pigment meter. Test spots were performed with escalating doses of alexandrite laser (ClearScan ALX, Sciton, Palo Alto, CA) deployed by a 7-mm spot equipped with a 30 mm x 30 mm scanner and a 10-ms pulse duration. Contact cooling was used, and temperature was maintained at 18°C to 20°C. Patients returned 4 to 7 days after test spots for evaluation for the purpose of optimizing settings. The highest settings that allowed for epidermal preservation and crusting of the hyperpigmented lesions were applied for the remainder of the treatment zones. Determinations of improvement were made by evaluation of photographs with standard settings using polarized and nonpolarized images. At each appointment, baseline pigment measurements were made to ensure there were no significant changes between treatment sessions. Two treatment sessions were performed approximately 4 weeks apart, and the final evaluation was 3 months after the final treatment.
Results:
Evaluation by a panel of blind observers determined a mean improvement of approximately 30%. Darker lesions responded better than lighter lesions. So-called low-contrast lesions performed the poorest. Pain was approximately 2/10 with the use of 5% lidocaine numbing cream applied approximately 45 minutes before each procedure. Pain was most severe where there was underlying hair.
Conclusion:
A long-pulse alexandrite laser equipped with contact cooling can achieve significant pigmentation improvement.
Noninvasive techniques for skin rejuvenation are quickly becoming standard in the treatment of mild rhytids and overall skin toning. Multiple laser wavelengths and modalities have been used with varying degrees of success, including 532-nm, 585-nm, 1064-nm, 1320-nm, 1450-nm, and 1540-nm wavelengths.
To evaluate a combination technique using a long-pulsed, 532-nm potassium titanyl phosphate (KTP) laser and a long-pulsed 1064-nm Nd:YAG laser, separately and combined, for noninvasive photorejuvenation and skin toning and collagen enhancement and to establish efficacy and degree of success.
Prospective nonrandomized study with longitudinal follow-up.
Private dermatologic surgery and laser practice.
A total of 150 patients, with skin types I through V, were treated with long-pulsed KTP 532-nm and long-pulsed Nd:YAG 1064-nm lasers, separately and combined. For the KTP 532-nm laser, the fluences varied between 7 to 15 J/cm2 at 7- to 20-millisecond pulse durations with a 2-mm handpiece and 6 to 15 J/cm2 at 30- to 50-millisecond pulses with a 4-mm handpiece. The 1064-nm Nd:YAG laser fluences were set at 24 to 30 J/cm2 for a 10-mm handpiece. These energies were delivered at 30- to 65-millisecond pulse durations. All subjects were treated at least 3 times and at most 6 times, depending on patient satisfaction level, at monthly intervals and were observed for up to 18 months after the last treatment.
All patients were asked to fill out a "severity scale" on which redness, pigmentation, rhytids, skin tone/tightness, texture, and patient satisfaction were noted before and after each treatment. Redness, pigmentation, rhytids, skin tone/tightness, and texture were also evaluated by the physician and another observer.
After 3 to 6 treatments, 50 patients treated with the 532-nm KTP laser alone showed improvement of 70% to 80% in redness and pigmentation, 30% to 50% in skin tone/tightening, 30% to 40% in skin texture, and 20% to 30% in rhytids. Another 50 patients treated with the 1064-nm Nd:YAG laser alone showed improvement of 10% to 20% in redness, 0% to 10% in pigmentation, 10% to 30% in skin tone/tightening, 20% to 30% in skin texture, and 10% to 30% in rhytids. The third group of 50 patients treated with both KTP and Nd:YAG lasers showed improvement of 70% to 80% in redness and pigmentation, 40% to 60% in skin tone/tightening, 40% to 60% in skin texture, and 30% to 40% in rhytids. Skin biopsy specimens taken at 1-, 2-, 3-, and 6-month intervals demonstrated new collagen formation.
All 150 patients exhibited mild to moderate improvement in the appearance of rhytids, moderate improvement in skin toning and texture, and great improvement in the reduction of redness and pigmentation. The KTP laser used alone produced results superior to those of the Nd:YAG laser. Results from combination treatment with both KTP and Nd:YAG lasers were slightly superior to those achieved with either laser alone.
Disorders of cutaneous pigmentation are a common problem, which can cause substantial cosmetic morbidity. Traditional treatments are often ineffective and sometimes associated with further hyperpigmentation, hypopigmentation, or scarring. Because the Q-switched ruby laser has proven useful for the treatment of tattoos and, in a small number of cases, benign disorders of the epidermal melanin, we decided to apply this modality systematically to additional benign pigmented lesions.
Thirty-four benign pigmented epidermal lesions including lentigines, café-au-lait macules, and nevi spili in nine white patients were exposed to single pulses of a Q-switched ruby laser (694 nm, 40 ns pulse duration) at 4.5 and/or 7.5 J/cm2.
After one treatment, substantial clearing occurred at each fluence in all lentigines and café-au-lait macules. Initial improvement was achieved in a small nevus spilus after two treatments at 4.5 J/cm2 and a larger nevus spilus after one treatment at 7.5 J/cm2 with complete removal of the junctional or compound nevi portion but no improvement in the café-au-lait portion. Complete return of the background pigment was observed by 1 year. There was no scarring. Immediately after treatment, histology revealed vacuolization of keratinocytes and melanocytes, and occasional subepidermal blisters.
These findings show that while the Q-switched ruby laser may not be entirely useful for treating nevi spili, it does provide an effective treatment for lentigines and café-au-lait macules.
Background:
Photodamaged skin is characterized not only by rhytides, but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, telangiectasias, laxity, and enlarged pores. There is growing interest in the development of noninvasive methods to treat photodamaged skin. Skin photorejuvenation is the visible improvement of photodamaged skin using a laser or other light source. A noncoherent, broadband, pulsed light source is effective in the treatment of vascular and pigmented lesions of the skin. This study evaluates the role of intense pulsed light in the rejuvenation of photo aged skin.
Objective:
The purpose of this study was to evaluate and quantify the degree of visible improvement in photodamaged skin following a series of full-face, intense pulsed light treatments.
Methods:
Forty-nine subjects with varying degrees of photo-damage were treated with a series of four or more full-face treatments at 3-week intervals using a nonablative, nonlaser intense pulsed visible light source. Fluences varied from 30 to 50 J/cm2. Subject evaluation and skin biopsies were used to assess treatment results.
Results:
All aspects of photodamage including wrinkling, skin coarseness, irregular pigmentation, pore size, and telangiectasias showed visible improvement in more than 90% of subjects with minimal downtime and no scarring. Eighty-eight percent of subjects were satisfied with the overall results of their treatments.
Conclusion:
Treatment of photodamaged facial skin using a series of full-face treatments with intense pulsed light is a new and effective noninvasive method of skin rejuvenation with minimal risk and no patient downtime.
Objective
The objective of this study was to evaluate the effectiveness of the pulsed dye laser (585 nm, 450 ms) in the treatment of sun induced wrinkles.DesignPatients had one pulsed dye laser (585 nm) treatment. The treated areas were assessed by the following methods: grading of skin wrinkles at 6 weeks, 12 weeks, and 6–14 months after treatment by blinded observers and by light and electron microscopy.SettingAn ambulatory care center at Abbott Northwestern Hospital (ANH) and the Laser & Skin Surgery Center of Northern California (LSSCNC).PatientsTwenty patients were treated, half with mild to moderate and half with moderate to severe sun induced skin wrinkles.ResultsAt last follow up 90% (9/10) of the mild to moderate wrinkles and 40% (4/10) of the treated patients with moderate to severe wrinkles had clinically observable improvement in their sun induced skin wrinkles. Histologic examinations of the treated areas showed a superficial dermal band of well organized elastin and collagen fibers replacing pre-treatment elastic tissue. Increased cellularity and mucin deposition was consistent with dermal collagen remodeling. Lasers Surg. Med. 25:229–236, 1999. © 1999 Wiley-Liss, Inc.
The risk of post-inflammatory hyperpigmentation (PIH) is increased during freckles and lentigines treatment in Asians.
To determine the effectiveness and safety of using 595-nm long pulsed dye laser (LPDL), 755-nm LP Alexandrite laser, 532-nm QS Nd:YAG laser and 532-nm LP potassium-titanyl-phosphate (KTP) laser for the treatment of freckles or lentigines in Asian patients. Methods: This is a retrospective study of 40 Chinese patients, who were divided into four groups based on treatment modality using four different pigment lasers. Each patient attended between 1 and 4 treatments (mean of 1.8), at 4-6 weeks intervals, depending on clinical response. Lesional clearance and PIH were assessed by two independent clinicians.
Statistically significant improvement of global and focal facial pigmentation was found after treatment with LPDL, QS Nd:YAG and LP KTP lasers. No significant improvement was found after LP Alexandrite laser. PIH risk was 20% after LP Alexandrite treatment, 10% with QS Nd:YAG, and absent after LPDL and LP KTP treatment.
A long pulse laser and small spot size appear to reduce the risks of lentigines treatment in darker skin types.
A variety of treatment modalities have been used to reduce the size of enlarged facial pores without obvious success.
To assess and compare the effects of various parameters of a 1064 nm Nd:YAG laser in the treatment of enlarged facial pores.
This was a prospective intra-individual left-right comparative study. A total of 40 individuals with enlarged facial pores were recruited for this study. Ten individuals were respectively treated on one half of the face with a quasi long-pulsed 1064 nm Nd:YAG laser (method 1), a Q-switched 1064 nm Nd:YAG laser (method 2), both quasi long-pulsed and Q-switched 1064 nm Nd:YAG lasers without carbon-suspended lotion (method 3), and both quasi long-pulsed and Q-switched 1064 nm Nd:YAG lasers with carbon-suspended lotion (method 4). The other half of the face was left untreated as a control. Five laser sessions were performed with a 3-week interval. The pore sizes were measured using an image analysis program and the sebum level was measured with a Sebumeter before and after the treatments.
The pore size and sebum level decreased in all four methods on the treated side compared to the control (p < 0.05).
Treatment with a 1064 nm Nd:YAG laser is an effective method for reducing pore size and sebum level.
Low-fluence carbon dioxide (CO2) laser irradiation of skin has previously been shown to induce damage limited primarily to the epidermis. To evaluate whether this technique was therapeutically effective for pigmented epidermal lesions, ten lentigines caused by methoxsalen and ultraviolet light therapy were treated in one patient using the CO2 laser at fluences ranging from 3.0 to 7.7 J/cm2 for 0.1-s exposures with 4.5-mm spot size. Based on substantial clearing in seven of ten lesions treated, 146 solar lentigines were treated in five patients at fluences of 3.0, 3.7, or 4.4 J/cm2. Biopsies were performed on a total of 30 lesions immediately and 24 hours, seven days, and six weeks after irradiation. Of 125 lesions followed up clinically for six weeks, 12 cleared completely, 81 lightened substantially, and 28 remained unchanged. Only two demonstrated atrophic change. Hyperpigmentation or hypopigmentation did not occur. All lesions that improved had been treated at 3.7 or 4.4 J/cm2. Immediate histologic injury consisted of vacuolar and spindly change and subsequent vesiculation limited to the basilar epidermis. Twenty-four hours later there was epidermal necrosis with regeneration, 0.1 mm of dermal basophilia and stromal condensation, and a mild inflammatory infiltrate. These alterations were dose-dependent, with near complete epidermal necrosis and superficial dermal involvement at the highest fluence, and only focal epidermal necrosis at the lowest. At seven days, epidermal regeneration was complete with traces of melanin remaining in keratinocytes. Melanophages first appeared at seven days and persisted at six weeks, by which time the inflammatory infiltrate had cleared. No lentiginous proliferation was evident and epidermal pigmentation had become normal. Low-fluence CO2 laser irradiation is an effective means of damaging the epidermis with only minimal dermal change. This mode of therapy is an effective way to lighten the pigmentation of lentigines without substantial scarring.
Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.
The removal of benign, aesthetically important, pigmented lesions can be effectively treated with multiple modalities. Selective removal of the pigment by lasers is becoming increasingly popular. A three-center trial evaluated the effectiveness of the frequency-doubled Q-switched neodymium (Nd):YAG laser (532 nm, 2.0-mm spot size, 10 nanoseconds) in removing benign epidermal pigmented lesions with a single treatment. Forty-nine patients were treated for multiple lentigines (n = 37), for cafe au lait macules (n = 7), and for miscellaneous lesions (n = 5). Treatment areas were divided into four quadrants, irradiated with fluences of 2, 3, 4, or 5 J/cm2 and evaluated at 1- and 3-month intervals following treatment.
For lentigines, response was related to dose with a greater than 75% pigment removal achieved in 60% of those lesions treated at higher energy fluences. Responses were more variable with other lesions, with fair-to-good improvement noted in most cases. Mild, transient erythema; hypopigmentation; and hyperpigmentation were noted in several patients, but resolved spontaneously within 3 months. No other textural changes, scarring, or other side effects were noted.
The frequency-doubled Q-switched Nd: YAG laser (532 nm) safely and effectively treats benign epidermal pigmented lesions.
Cryogen spray cooling can be used to provide epidermal protection while still achieving spatially selective photocoagulation in the upper dermis. The objective of this study is to determine the efficacy and safety of cryogen spray cooling in combination with a nonablative Nd:YAG (lambda = 1320 nm) laser treatment of facial rhytides in human volunteers.
Thirty-five adults with bilateral periorbital rhytides were treated with cryogen spray cooling in combination with 3 nonablative laser treatments performed sequentially at intervals of 2 weeks. Small but statistically significant improvements were noted in the mild, moderate, and severe rhytid groups 12 weeks after the final laser treatment. A final assessment performed 24 weeks after the last treatment showed statistically significant improvement only in the severe rhytid group. The procedure was found to be safe; 4 sites (5.6%) developed transient hyperpigmentation. Two sites (2.8%) subsequently developed barely perceptible pinpoint pitted scars.
Cryogen spray cooling is a safe and effective method for protecting the epidermis during nonablative laser treatment of facial rhytides thereby avoiding much of the morbidity associated with other resurfacing procedures. Minor improvements in rhytides can be achieved with the current technology. Optimization of treatment parameters may further improve these results.
Skin resurfacing and wrinkle removal is a large medical laser market. However, the rate of undesirable side effects is high and sometimes is not warranted by the aesthetic improvement observed. The authors have evaluated the potential benefits of an approach to selective non-ablative wrinkle reduction.
This technique selectively targets the microvasculature which plays a key role in the stimulation of enhanced collagen production.
The study reported shows that application of the laser parameters described enhances collagen production by an average of 84%, measured 72 hours after a single laser treatment. This is achieved whilst leaving the skin barrier intact and with no adverse pigmentary changes. The study further shows that a cosmetic improvement is observed with an average value of 1.88 reduction in wrinkle appearance as measured on the Fitzpatrick Wrinkle Severity scale. This improvement was achieved with one brief treatment and no reported incidence of side effects.
In conclusion, the treatment modality described may be a new approach to the treatment of wrinkles.
We present a new theory of selective thermal damage of non-uniformly pigmented structures in biological tissues. Spatial separation of the heavily pigmented areas and the target requires limitation of the pigment temperature and heat diffusion from the pigmented to the targeted areas.
A concept of selective target damage by heat diffusion is presented for three target geometries: planar, cylindrical, and spherical. An in vitro experiment is described in which the dependence of thermal damage on pulsewidth at constant fluence was evaluated.
The in vitro experiment showed that the size of the damage zone for similar hair follicles was pulsewidth-independent over a very broad range of pulsewidths (30-400 ms). We formulated a new theory (extended theory of photothermolysis) to interpret the experimental results.
Based on this new theory, the treatment pulsewidth for non-uniformly pigmented targets is significantly longer than the target thermal relaxation time (TRT). The theory provides new recommendations for photoepilation and photosclerotherapy parameters.
A laser with a wavelength in the mid-IR range targeting the depth in skin where sebaceous glands are located in combination with cryogen spray cooling was evaluated for treatment of acne. In this non-ablative treatment, the laser energy heats the dermal volume encompassing sebaceous glands whereas the cold cryogen spray preserves the epidermis from thermal damage.
Monte Carlo simulations and heat transfer calculations were performed to optimize the heating and cooling parameters. A variety of heating and cooling parameters were tested in an in vivo rabbit ear study to evaluate the histological effect of the device on sebaceous glands and skin. Similar experiments were performed on ex vivo human skin. A clinical study for the treatment of acne on backs of human males was also conducted.
Monte Carlo simulations and heat transfer calculations resulted in a thermal damage profile that showed epidermal preservation and peak damage in the upper dermis where sebaceous glands are located. Ex vivo human skin histology confirmed the damage profile qualitatively. In vivo rabbit ear histology studies indicated short-term thermal alteration of sebaceous glands with epidermal preservation. In the human clinical study on the back, a statistically significant reduction in lesion count on the treated side compared to the control side was seen (p < 0.001). Side effects were transient and few.
The studies reported here demonstrate the feasibility of treating acne using a photothermal approach with a mid-IR laser and cryogen cooling.
A variety of laser systems have recently become available that allow for selective dermal remodeling without disruption of the epidermal surface. Modest clinical improvement in mild to moderate photoinduced facial rhytides with minimal morbidity is typical of these nonablative lasers, providing a significant advantage over traditional ablative laser systems.
To determine the clinical and histologic effects of a novel 1540 nm erbium glass laser on facial rhytides.
Patients with mild to moderate periorbital and perioral rhytides received a series of three monthly treatments with a 1540-nm erbium-doped phosphate glass laser by a single operator. Photographic and clinical evaluations were independently conducted by the patient and a masked medical observer at each treatment visit and at 1, 3, and 6 months following the final treatment session. Skin biopsies were obtained for histologic analysis by a board-certified dermatopathologist at baseline, immediately following laser irradiation, and at one and six months post-treatment.
Slow, progressive clinical improvement of rhytides was noted in all patients after each treatment and continued throughout the extended follow-up period. Side effects of treatment were limited to transient erythema and edema immediately following laser irradiation. No serious adverse effects were noted. Histologic skin changes were not apparent until several months following treatment, when an increase in dermal collagen was noted.
The nonablative 1540 nm erbium glass laser system with contact cooling produces gradual clinical and histologic improvement in mild to moderate facial rhytides with minimal risk of serious adverse sequelae.
Improvement in the appearance of wrinkles has been observed following exposure to short-pulsed 585 nm laser light. The assumed effect is a specific absorption of light in the blood vessels of the superficial dermis, resulting in release of inflammatory mediators into the interstitium followed by stimulated fibroblast activity. The fibroblasts effectively initiate tissue repair mechanisms, which include enhanced new collagen production.
Quantitative measures of collagen synthesis rate in the skin can be obtained from determinations of the aminoterminal propeptide of type III procollagen level in suction blister fluid using a radioimmunoassay.
A single laser treatment at subpurpura energy level showed that the 585 nm laser source induced an increase of 84% (p < 0.05) in the type III procollagen production rate compared with a non-treated control site. A broadband, pulsed, white light source at 4 J/cm(2) showed no measurable increase, whilst the skin area treated with 7 J/cm(2) increased the procollagen production rate by 17% (NS, p > 0.05). A second treatment 2 weeks later further improved the laser-induced increase in procollagen production rate to 148% (p < 0.05) compared with the control site. The broadband, pulsed, white light-irradiated skin sites showed that at 4 J/cm(2) the procollagen production rate was increased by 21.4% and at 7 J/cm(2) by 32.1% compared with the corresponding non-treated control site (NS, p > 0.05).
Irradiation by the haemoglobin-specific short-pulsed 585 nm laser induced a fivefold increase in procollagen production rate compared with a biologically comparable fluence delivered in a broadband spectrum. An additional treatment after 2 weeks further increased the effect of the short-pulsed 585 nm laser to 148% of the control. Vascular-specific light/tissue interactions seem to play a key role in stimulating skin collagen production.
This study was performed to evaluate the effectiveness and safety of erbium:YAG laser in removal of cutaneous lesions.
Data were collected after removing 363 benign, pre-malignant and malignant lesions in 27 patients at a dermatology and cosmetic laser surgery center.
All lesions were completely removed. Eight of 363 lesions recurred and the histological analysis showed complete removal of one malignant lesion with erbium:YAG laser ablation. There were no long term or permanent complications.
Erbium:YAG laser is safe and effective in removal of cutaneous lesions.
We introduce and clinically examine a new concept of skin treatment called fractional photothermolysis (FP), achieved by applying an array of microscopic treatment zones (MTZ) of thermal injury to the skin.
Two prototype devices emitting at 1.5 microm wavelength provided a pattern of micro-exposures with variable MTZ density. Effects of different MTZ densities were tested on the forearms of 15 subjects. Clinical effects and histology were assessed up to 3 months after exposure. Treatment of photoaged skin on the periorbital area in an additional 30 subjects receiving four treatments over a period of 2-3 weeks was also tested. Tissue shrinkage and clinical effects were assessed up to 3 months after treatment.
Pattern densities with spacing of 250 microm or more were well tolerated. Typical MTZ had a diameter of 100 microm and penetrated 300 microm into the skin. Reepithelialization was complete within 1 day. Clinical effects were assessed over a 3-month period. Histology at 3 months revealed enhanced undulating rete ridges and increased mucin deposition within the superficial dermis. Periorbital treatments were well tolerated with minimal erythema and edema. Linear shrinkage of 2.1% was measured 3 months after the last treatment. The wrinkle score improved 18% (P < 0.001) 3 months after the last treatment.
FP is a new concept for skin restoration treatment. Safety and efficacy were demonstrated with a prototype device. Further clinical studies are necessary to refine the optimum parameters and to explore further dermatological applications.
Pulsed 532-nm lasers have been widely used in the treatment of vascular and pigmented conditions of aged skin. In addition to lesion clearance, many patients report color and texture improvements to the skin. These improvements are often difficult to appreciate from photographic analysis alone, but are significant to the patient's impression of treatment success.
To grade and compare objective and subjective results of treatments with a 532-nm frequency-doubled pulsed Nd:YAG laser using criteria of skin color, skin texture, and wrinkles based on a blinded retrospective analysis of photographs compared with results from patient questionnaires.
Clinical before and after pictures from 20 patients (skin types I-IV) treated for diffuse vascular and pigmented lesions were selected for evaluation. A blinded grading was performed using criteria of skin color, skin texture, and wrinkles. Patients were asked by questionnaire to also grade improvement using the same criteria. The results of the blinded and patient grading were reported and compared using a chi-squared analysis.
Clinical improvements recorded by blinded photographic evaluation and patient evaluation agreed with no statistically significant differences. Both the blinded observers and patients recorded remarkable improvement in the color signs of photoaging, slight to moderate improvement in skin texture and fine wrinkles, and negligible improvement of medium depth and deep wrinkles.
The 532-nm pulsed laser is a safe and effective device for the treatment of the visible signs of photoaging of skin types I-III. In addition to improvements in color defects, objectively and subjectively significant improvements in texture and fine wrinkles can be expected. Little to no improvement in medium to deep wrinkles can be anticipated.
The treatment of photodamaged skin with potassium-titanyl-phosphate (KTP) laser and intense pulsed light (IPL) has been reported in several studies. Each device has strengths and weaknesses; however, patient and device variability have made it difficult to ascertain the optimal device for photorejuvenation. The objective of this study was to obtain a head-to-head comparison of IPL and KTP laser for photorejuvenation. Each patient received one KTP laser treatment on one side of the face and one IPL treatment on the other side.
Seventeen patients with skin types I-IV were accepted into the study based on existence of dyschromias (pigmented and vascular) and/or discrete telangiectases. After performance of test spots on each patient to determine optimal settings for both devices, patients were treated with both devices in a split face manner. Evaluations and photographs were performed 1 week and 1 month after treatment. Patient and observer evaluations of results were recorded, as well as time to perform each treatment, and patient feedback with regard to pain and edema. No anesthesia was used in these treatments. Photographs were reviewed by a panel of blinded observers to assess changes in red and brown dyschromias.
One month average improvement (evaluator) for IPL side was (mean) 38.16%/35.08% for vascular/pigment lesions versus 41.99%/30.21% for KTP side. Patient self-evaluated global improvement at 1 month was (mean) 65.59% for IPL side versus 60.88% for KTP side. A majority of patients found the KTP to be slightly more painful with a mean pain rating of 5.27 of 10 versus 4.4 of 10 for IPL. A majority of patients experienced subjectively greater post-procedure swelling on the KTP side. Time to conduct treatment was an average of 10.0 minutes for IPL, 8.7 minutes for KTP.
Both large spot KTP and IPL achieved marked improvement in vascular and pigmented lesions in one session. The KTP laser caused slightly more discomfort and edema than the IPL. On the other hand, the KTP laser was faster, and more ergonomically flexible.