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Single treatment scar resurfacing with a novel ablative fractional 2910 nm erbium‐doped fluoride glass fiber laser
This book chapter focuses on lasers using fractional photothermolysis (FP) technology to rejuvenate and enhance the youthfulness of our skin. FP creates microscopic treatment zones (MTZs) while sparing the surrounding skin, facilitating faster re-epithelization of the treated area. This chapter discusses about the historical background and advancements in ablative fractional laser (AFL), nonablative fractional laser (NAFL), and hybrid lasers. Additionally, it discusses strategies for optimizing outcomes for patients undergoing skin rejuvenation treatments.
Background
Acne scarring results from the inflammation associated with acne papules, which alters dermal collagen, typically producing depressed scars. Lasers have been used to remodel skin improving the texture and appearance of acne scars. Herein, we investigate a new 2910 nm, erbium‐doped, fluoride glass, fiber laser for improving acne scars. This novel laser delivers up to 5000 Hz low‐energy pulses, providing a unique treatment modality.
Methods
Fourteen subjects with rolling and/or boxcar acne scars were enrolled in this study. Thirteen subjects completed the final visit and received three treatments with the 2910 nm fiber laser at 6–8‐week intervals. Eight subjects were Fitzpatrick type II and five were Fitzpatrick type III. Digital images were taken pre‐ and 1‐ and 3‐months posttreatment and evaluated by two blinded reviewers in a randomized fashion for improvement. Subjects and the treating physician completed a Global Aesthetic Improvement Scale (GAIS) before treatment and at each visit to subjectively evaluate treatment effect. Histological analysis was performed on ex vivo lower eyelid skin samples. Side effects were evaluated by the treating physician and included erythema, edema, and pinpoint bleeding.
Results
Evaluation of blinded digital images revealed a mean improvement of 47.3% ± 14.2% (mean ± SEM) 3 months following the final treatment. GAIS scores demonstrated improvement as evaluated by both the subjects and the treating physician. Side effects averaged trace‐to‐mild erythema, edema, and pinpoint bleeding.
Conclusion
This study shows that the 2910 nm, erbium‐doped, fluoride glass, fiber laser is safe and effective for improving the appearance of acne scars.
Introduction
Laser technology has fundamentally transformed the landscape of dermatology, offering nuanced solutions for skin rejuvenation and resurfacing. This paper aims to explore the spectrum of laser technologies, from ablative to non‐ablative and fractional lasers, their mechanisms, benefits, and tailored applications for diverse skin conditions. As we delve into the intricacies of each technology, we also consider the scientific advancements that have made these treatments safer and more effective, promising a new horizon in skin rejuvenation.
Objective
This comprehensive analysis seeks to evaluate recent advancements in laser technology for skin rejuvenation, focusing on efficacy, safety, and patient satisfaction.
Methods
The selection criteria for studies in this publication focused on recent, peer‐reviewed articles from the last 20 years, emphasizing advancements in laser technologies for skin rejuvenation. Our comprehensive review involved searches in PubMed, Cochrane, Scopus and Google Scholar using keywords like “skin rejuvenation,” “laser technology,” “efficacy,” “safety,” and “dermatology.” This approach focused on inclusion of recent research and perspectives on the efficacy and safety of laser treatments in the field of dermatology.
Results
Our literature review reveals advancements in laser skin resurfacing technologies, notably fractional lasers for minimal downtime rejuvenation, ablative lasers for precise tissue vaporization, and non‐ablative lasers for coagulation effect promoting collagen with reduced recovery. Hybrid and picosecond lasers are highlighted for their versatility and effectiveness in addressing a wide array of skin concerns. The findings also emphasize the development of safer treatment protocols for ethnic skin, significantly reducing risks like hyperpigmentation and scarring, thus broadening the scope of effective dermatological solutions.
Conclusion
This extensive review of advancements in laser technologies for skin rejuvenation underscores a remarkable evolution in dermatological treatments, offering an expansive overview of the efficacy, safety, and patient satisfaction associated with these interventions. Furthermore, the exploration of combination treatments and laser‐assisted drug delivery represents a frontier in dermatological practice, offering synergistic effects that could amplify the therapeutic benefits of laser treatments.
Severe scarring is known for causing severe functional, aesthetic, and psychosocial impairments. During the last years, treatment of mature scars has evolved significantly; however, researchers and clinicians are more and more focused on preventing excessive scarring altogether, thus avoiding long and strenuous treatment. While some forms of scar prevention have been known and used for decades, others are relatively new and have yet to prove themselves. Pressure garments have long been successfully used in widespread burn scar prevention. However, reduced compliance, large treatment costs, and little hard evidence are points that should be taken into consideration regarding this well-established form of treatment. Silicone gel sheeting has also been used for a long time, and it is well regarded for its efficacy in reducing scar height and improving pliability while boasting little side effects. Its mode of action, however, remains unclear. Recently, lasers have become a new focus in the effort to prevent pathological scarring. Here, the older pulsed dye laser, as well as newer, fractional ablative and nonablative lasers, is increasingly employed for the treatment of fresh scars, where initial research is showing significant promise.
This chapter explores the currently available methods for scar prevention and examines their application and the evidence regarding their efficacy.
Hypertrophic scars (HTS) following burns and other trauma and are associated with significant functional and psychosocial impairment. Ablative fractional lasers (AFLs) are increasingly being applied in the treatment of HTS supported by a rapidly expanding multidisciplinary base of literature. The multidisciplinary authors sought to evaluate existing literature, provide context and identify gaps, and make recommendations for a path forward. A systematic review was conducted to identify literature pertinent literature through September 2019. Retrospective cohort, randomized controlled trials, quasi-randomized controlled trials, observational prospective cohort, or case series with five or more subjects with hypertrophic scars incurred from burns and related trauma were considered. Twenty-two of the 23 evaluated studies documented statistically significant and/or meaningful qualitative improvements in nearly all outcome measures. Adverse events were generally infrequent and minor. Significant heterogeneity was observed among the studies included in this systematic review, precluding metaanalysis of pooled data. There is abundant existing literature on the use of AFLs in the management of HTS but study heterogeneity limits generalizability. Future studies should prioritize standardized protocols including assessments of function and quality of life.
Background:
Facial rejuvenation by lasers that target water has been a mainstay of esthetic laser treatments for decades. Modern lasers more commonly treat a fraction of the skin surface using ablative, semi-ablative or non-ablative pulses.
Methods:
Twenty subjects with visible evidence of chronic photoaging on the face were enrolled in this study. All subjects received two full face, single pass treatments spaced 2 months apart with the superficial mode of a 2,910 nm fiber laser with an estimated penetration depth of 10 microns, 25% coverage, delivered in a 15mm x 15mm square microbeam pattern. Blinded comparison of pre- and 3-month post-treatment images was performed. Biopsy samples for evaluation of laser-tissue effects was performed on 3 separate subjects and harvested 1-day, 1-week, and 2-weeks post-treatment.
Results:
Blinded evaluation of digital images revealed an average improvement score of 25.1. + 14.5 (mean + sem) or 25.1%, using an 11-point scale evaluating overall improvement in photoaging (p<0.001). Post-treatment effects were limited to mild-to-moderate erythema and edema, and pain was rated a 1.9 out of maximum of 10. Histology demonstrated superficial changes in the stratum corneum and epidermis with dermal inflammation present at 1-day and 1-week post-treatment, with return to baseline at 2-weeks.
Conclusions:
The 2,910 nm fiber laser is safe and effective for improving mild photodamage, with minimal discomfort and downtime. Dermal inflammation results from very superficial epidermal injury and may contribute to clinical improvement. This article is protected by copyright. All rights reserved.
Background and objectives:
Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs.
Study design/materials and methods:
An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence.
Results:
The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome.
Conclusion:
Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.
Background and objectives:
This paper describes the laser techniques available for the treatment of surgical and trauma scars and develops recommendations for an algorithmic-based treatment approach based on extensive clinical experience and published data.
Study design/materials and methods:
We reviewed the literature regarding laser treatment of surgical and traumatic scars and incorporated the clinical experience of the authors to develop an algorithm for the treatment of surgical and trauma scars.
Results:
In order to develop treatment recommendations, scars were differentiated based on their clinical characteristics. Specific scar characteristics aid in determining the appropriate treatment strategy for different types of complex surgical and trauma scars.
Conclusion:
Laser therapy is first-line therapy for traumatic and surgical scars. The treatment approach should be guided by scar characteristics (e.g., anatomic location, type of injury, color, thickness, tension, scar age, and activity) and involves choosing the appropriate laser type and determining the benefit of combination therapy with surgical and nonsurgical treatment modalities to optimize treatment responses. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.