长脉冲1064nm Nd：YAG激光治疗面部激素依赖性皮炎伴发的毛细血管扩张

目的：观察长脉冲1 064nm Nd：YAG激光治疗面部激素依赖性皮炎伴发毛细血管扩张的临床治疗效果。方法：治疗参数选用：光斑直径3mm,平均脉宽（13.5±3.4）ms,平均能量密度（267.2±3.1）J/cm2。结果：37例女性患者,平均治疗2.3次,面部毛细血管扩张平均密度由（2.76±1.03）根/cm2下降至（0.42±0.27）根/cm2,临床疗效显著。治疗后,皮肤恢复至基本正常状态,无瘢痕、色素改变,皮炎反复发作的现象消失。结论：长脉冲1 064nm Nd：YAG激光治疗面部激素依赖性皮炎伴有的毛细血管扩张具有较好临床治疗效果,方法值得进行更广泛的临床实践与深入研究。     

Treatment of face veins with a cryogen spray variable pulse width 1064 nm Nd:YAG Laser: a prospective study of 17 patients.

BACKGROUND: Through the 1990s laser treatment of leg veins has been a challenge. Newer, longer wavelength lasers with variable pulse width have shown promising results for both telangiectasia and reticular leg veins. Experience with these lasers for treatment of facial telangiectasia and periorbital reticular veins is scant. OBJECTIVE: To our knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray-equipped 1064 nm Nd:YAG laser for the treatment of facial telangiectasia and larger periorbital reticular veins. METHODS: Seventeen volunteers, ages 32-67 years, skin types I-IV, with facial telangiectasia and reticular periorbital/temporal veins were treated once with the Nd:YAG laser at fluences of 125-150 J/cm2 with a 6 mm spot size and pulse widths of 25 msec for small vessels and 75-100 msec for reticular veins. Patients were examined 1 week and 1 month after the treatment. Pre- and posttreatment 35mm photographs were taken. Improvement was judged by two experienced physicians, both visually on patients and by comparison of pre- and posttreatment photographs. Results were graded as percent resolution, in five groups: 0%, 0-25%, 25-50%, 50-75%, and 75-100%. RESULTS: All 17 patients completed the study. Thirty-two sites were treated (24 cheek, nose, and chin telangiectases, and 8 periorbital reticular veins). Greater than 75% improvement was observed in 97% of the treated sites. Greater than 50% improvement was observed in 100% of the treated sites. Notably, 100% of the facial reticular veins treated have essentially 100% resolution. Pain during treatment was variably perceived by patients, but occasionally sufficient for patients to express reservations about additional future treatment. Transient erythema and edema were common, but fine crusting was rare. Small areas of purpura were also quite rare. CONCLUSION: The cryogen spray-equipped 1064 nm Nd:YAG laser was remarkably effective and safe for skin type I-IV patients. It is an excellent tool for treatment of facial telangiectasia with minimal risk of purpura. For the first time we appear to have a simple, safe, and effective treatment for 1-2 mm periorbital reticular veins. The use of topical anesthesia may be needed for some patients.     

Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite Laser

BACKGROUND: Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. OBJECTIVE: To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I-V. METHODS: Eighty-nine untanned patients with skin types I-V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4-6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10-15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm(2), a spot size of 12 mm was used for fluences of 35-40 J/cm(2), and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm(2). Fluences ranging from 20 to 50 J/cm(2) (mean fluence 36 J/cm(2)) were used. RESULTS: The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm(2) (35-50 J/cm(2)) and a 10-12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm(2) (30-40 J/cm2) and a 12-15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm(2) (25-40 J/cm(2)) and a 12-15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25-35 J/cm(2)) and a 12-15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm(2) (20-25 J/cm(2)) and a 12-15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. CONCLUSION: The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I-V. The best results are achieved in untanned patients with skin types I-IV.     

Facial Rejuvenation with a Nonablative 1320 nm Nd:YAG Laser:

BACKGROUND: Rejuvenation of photoaged skin involves removal of the epidermis and superficial dermis, encouraging the production of new epidermis with collagenesis and remodeling. The facial appearance during healing is unpleasant, and the complication rate is high. OBJECTIVE: We evaluate a Q-switched Nd:YAG laser operating at 1320 nm, with a cryogen delivery system and a skin temperature sensor. The system cools the target skin, followed by the laser impulse which passes through the cooled epidermis into the dermis. METHODS: Ten patients are presented. Two treatments a week were given over 4 weeks, and the patients were seen at 2 and 6 weeks after the final treatment. RESULTS: The histology showed improvement in the condition of the dermis in all 10 patients, but only 2 of the 10 patients expressed satisfaction with the results, despite similar histologic findings. CONCLUSIONS: Careful patient selection is required. Better patient education is necessary to ensure that the patients' expectations are realistic. We should add treatments that will improve the youthful aspect of the epidermis. The system may well help in maintaining the effects of collagen remodeling following traditional ablative resurfacing procedures, but studies are necessary to show this.     

强脉冲光及Nd:YAG(1064nm)激光治疗皮肤血管瘤疗效观察

目的:评价应用强脉冲光及Nd:YAG(1064nm)激光治疗皮肤血管瘤的临床效果。方法:回顾并随访2006年1月～2010年12月在笔者科室采用强脉冲光及Nd:YAG(1064nm)激光治疗的476例皮肤血管瘤患者,对其疗效进行分析。结果:随访2年,皮肤浅表血管瘤治愈率为88.4%,有效率为10.7%,深浅混合血管瘤联合药物注射治疗的治愈率为78.4%、有效率为17.6%,副作用轻微。结论:强脉冲光及Nd:YAG(1064nm)激光治疗皮肤血管瘤疗效好、治疗次数少、安全性高,值得推广。     

Q开关Nd:YAG1064nm激光联合强脉冲光治疗56例颧部褐青色痣临床疗效探讨

目的 观察Q 开关Nd:YAG1064nm激光与强脉冲光570～950nm 联合治疗颧部褐青色痣的临床疗效.方法 采用Q 开关Nd:YAG1064nm激光与强脉冲光570～950nm对56例颧部褐青色痣患者行联合治疗;每次治疗前根据皮损状况的不同,选用不同的治疗方式,不同的治疗参数;治疗间隔期积极采用促进色素代谢及组织修复等辅助疗法.结果 56例患者总有效率为100%.痊愈39例,显效13例,有效4例,无效0例..所有患者中Q开关激光治疗1次者18例,2次者31例,3次者7例.结论 Q 开关Nd:YAG1064nm激光与强脉冲光联合治疗颧部褐青色痣疗效可靠,且减少了炎症后色素沉着的发生率,缩短了治疗时间,患者满意度明显提高.     

Full-Face Nonablative Dermal Remodeling with a 1320 nm Nd:YAG Laser

BACKGROUND: Full-face laser-induced dermal remodeling has traditionally involved ablative methods with their associated complications and limitations. Rhytide improvement requires, among other things, dermal collagen remodeling. Such remodeling has been shown to occur without the requirement of epidermal ablation. OBJECTIVE: To evaluate the investigator's objective and patient's subjective improvement seen after full-face treatment with a 1320 nm Nd:YAG laser. METHODS: Ten patients with class I-II rhytides and Fitzpatrick skin types I-II were treated five times over 3-4 week intervals with a 1320 nm Nd:YAG laser. Patients were evaluated for degree of clinical improvement 6 months after their final treatment. RESULTS: All 10 subjects reported subjective improvement in the quality of their skin. Only six subjects were felt by the investigator to show definitive clinical improvement. Six-month posttreatment biopsies showed evidence of new collagen formation. CONCLUSION: Irradiation with 1320 nm Nd:YAG laser can lead to new collagen formation and associated clinical improvement. Such full-face improvement can occur without epidermal ablation.     

Q开关1064nm Nd:YAG激光联合珍珠美白散治疗黄褐斑疗效探讨

目的:探讨Q开关1064nm Nd:YAG激光联合珍珠美白散治疗黄褐斑的临床疗效。方法:选取2016年4月-2019年4月在笔者医院接受治疗的黄褐斑患者110例作为研究对象,采用随机数字表法将其分为观察组(n=56)和对照组(n=54)。观察组采用Q开关1064nm Nd:YAG激光联合珍珠美白散治疗,对照组采用Q开关1064nm Nd:YAG激光治疗。对比两组临床疗效、皮损总积分、积分下降指数、不良反应率及复发率。结果:治疗后,观察组临床总有效率明显高于对照组(92.86 vs 66.67)%(P<0.05);观察组皮损总积分明显低于对照组(1.27±0.26 vs 2.87±0.38)分,且积分下降指数明显高于对照组(0.66±0.07 vs 0.52±0.06)(P<0.05);观察组不良反应率明显低于对照组(3.57 vs 53.70)%(P<0.05);观察组复发率明显低于对照组(1.79 vs 18.52)%(P<0.05)。结论:Q开关1064nm Nd:YAG激光联合珍珠美白散治疗黄褐斑临床疗效理想,有效改善皮损状况,且对降低复发率及不良反应率效果显著,值得在临床上推广及应用。     

Short-Term Histologic Effects of Nonablative Resurfacing: Results with a Dynamically Cooled Millisecond-Domain 1320 nm Nd:YAG Laser

BACKGROUND: It is widely believed that nonablative laser techniques can lead to dermal collagen remodeling without the obvious epidermal injury and the wound created with ablative approaches. This occurs when dermal collagen injury is induced without visible injury to the overlying epidermis. OBJECTIVE: To examine the acute histologic effects both 1 hour and several days after standardized treatment protocols of dynamically cooled millisecond domain Nd:YAG 1320 nm laser to provide further insight into the mechanism of action of nonablative resurfacing. METHODS: Multiple adjacent sites on the preauricular area of the cheek of 10 patients were biopsied following one to three laser passes of dynamically cooled millisecond-domain Nd:YAG 1320 nm laser. Biopsies were performed at 1 hour and at 3 days following a single treatment. The number of passes was varied from one to three and Tmax (peak temperature measured by integrated radiometer) during treatment was targeted for 45-48 degree C. RESULTS: At 1 hour after treatment, epidermal spongiosis and edema of the basal cell layer were present in all the specimens treated with three passes. At 3 days the three pass samples also showed microthrombosis, widened vessels, sclerosis of the vessel walls, and infiltration of neurophilic granulocytes. The occurrence of these histologic findings correlated well with the presence of clinical improvement (judged by photographs) at 8 weeks after treatment. Acute histologic changes and clinical improvement were not observed below treatment temperatures of Tmax 45 degree C or after one pass alone. Repeated temperatures above a Tmax of 48 degree C incurred risk of epidermal injury. CONCLUSION: Even though longer-term histologic findings have confirmed the collagen synthesis component of 1320 nm Nd:YAG laser, our data indicate that there may be some additional factors other than dermal collagen heating with subsequent collagen repair. The concept of true "nonablative resurfacing" may involve some form of subclinical epidermal injury that improves the clinical outcome. Acute changes involving superficial blood vessel injury with cytokine release may also be implicated. Our histologic findings suggest that three passes with fluence and cooling adjusted to a Tmax of 45 degree C-48 degree C yields improved clinical results.     

长脉宽1064nm Nd：YAG激光治疗黄褐斑疗效观察

目的：探讨长脉宽1064nm Nd：YAG激光治疗黄褐斑的临床疗效和安全性。方法：选取12例面部黄褐斑患者,采用长脉宽1064nm Nd：YAG激光,光斑直径5mm,脉宽0.3～0.4ms,能量13～15J/cm2,频率7～10Hz,全面部每次扫描约6000～12000个脉冲,共治疗10次,每2周1次,术后严格防晒。每次治疗前采用MASI评分和前后照片比较改善效果。结果：12例经过10次治疗,黄褐斑患者均获得不同程度改善,其中3例的改善率达到了60%,5例达到50%以上的改善。无1例出现严重副反应,同时还有改善皮肤质地的作用,80%以上的患者表示满意。结论：长脉宽1064nm Nd：YAG激光治疗黄褐斑疗效确切,安全性高,无明显副作用,是一种治疗黄褐斑安全、有效的新方法。     

Successful Treatment of Spider Leg Veins with a High-Energy, Long-Pulse, Frequency-Doubled Neodymium:YAG Laser (HELP-G)

BACKGROUND: While sclerotherapy has been the standard treatment for spider leg veins for many years, recent advances have allowed lasers to be considered as a treatment option. OBJECTIVE: To study the efficacy of a frequency-doubled Nd:YAG laser at 532 nm with a 50 ms pulse width and chill tip device in the treatment of spider leg veins. METHODS: Forty-six patients with spider leg veins with a diameter of less than 1 mm or 1-2 mm were treated with a frequency-doubled Nd:YAG laser at 532 nm with a pulse width of 50 ms (VersaPulse HELP-G laser) while using a water-cooled chill tip device. RESULTS: Of patients with veins less than 1 mm in diameter, 60% had greater than 50% clearing after one treatment and 80% had greater than 50% clearing after two treatments. Of patients with veins 1-2 mm in diameter, 39% achieved greater than 50% clearing after one treatment and 67% had greater than 50% clearing after two sessions. CONCLUSION: Our results suggest that the frequency-doubled Nd:YAG laser with a pulse width of 50 ms and chill tip device offers an excellent alternative to sclerotherapy in the treatment of small spider leg veins.     

Laser Lipolysis Using a Novel 1,064 nm Nd:YAG Laser

BACKGROUND: We studied the safety and efficacy of a 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with a 300-micron fiber for the reduction of small unwanted fat areas. METHODS: Thirty subjects with focal areas of fat less than 100 cc were enrolled. Ten subjects were treated with laser lipolysis and had magnetic resonance imaging (MRI) at baseline and 3 months post-treatment. Ten subjects had laser lipolysis followed by biweekly treatments with the Tri-active system. The last group of 10 subjects served as control. Patients were seen at baseline and 1-week, 1-month, and 3-month follow-up visits. RESULTS: Twenty-nine patients completed the study. Self-assessment evaluations reported an improvement of 37% at the 3-month follow-up visit. MRI demonstrated an average 17% reduction in fat volume. Smaller baseline volume areas, such as the submentum, had better results, suggesting a dose-response relationship. The most common side effects were mild bruising and swelling resolving within 2 weeks. CONCLUSION: Laser lipolysis using the 1,064 nm Nd:YAG laser with a 300-micron fiber appears to be a very promising procedure that delivers good, reproducible results safely and effectively. The advantages include excellent patient tolerance, quick recovery time, and the benefit of dermal tightening.     

Patient Satisfaction and Reported Long-Term Therapeutic Efficacy Associated with 1,320 nm Nd:YAG Laser Treatment of Acne Scarring and Photoaging

BACKGROUND AND OBJECTIVE: Nonablative laser treatments have become increasingly used for the treatment of acne scarring and photoaging. While nonablative laser treatments are more convenient and relatively safer than ablative laser resurfacing, efficacy and patient satisfaction with the level of improvement of textural abnormalities in acne scarring and rhytids associated with photoaging needs further study. DESIGN/MATERIALS AND METHODS: Structured interviews were performed with 34 patients from a referral-based academic practice who each previously received a series of 6 monthly treatments with a 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for treatment of acne scarring or photoaging. Topical anesthesia was applied 1 hour before each treatment. Patients were interviewed at least 3 months after cessation of treatment (range 3-12 months). RESULTS: Patients tolerated the treatments well. Combined results for acne scarring and photoaging patients were as follows: (a) patient satisfaction with treatment was rated at 62%, and (b) textural improvement was reported at 31% at the end of the six treatments, and 30% at the date of interview. When results were stratified by diagnosis, patient satisfaction was slightly higher for treatment of acne scarring than for photoaging. Overall degree of improvement on a 1-10 scale was 5.4 for acne scarring and 3.8 for wrinkling. CONCLUSION: Nonablative treatment with the 1,320 nm Nd:YAG laser induced significant patient-reported improvement in both acne scarring and photoaging. The majority of patients reported satisfaction with the degree of improvement.     

肥大细胞在长脉宽1064nm Nd：YAG激光非剥脱性嫩肤中的作用

目的：本研究的目的是探讨肥大细胞在非剥脱性激光嫩肤中的作用。方法：应用长脉宽1064nm掺钕：钇-铝石榴石（neodymium-yttrium-aluminum garnet,Nd：YAG）激光对36只雌性昆明小鼠进行连续4次治疗,每次间隔1周。分别于第1次治疗后1h、1天、7天、21天、30天、60天对小鼠皮肤行活组织取材。应用甲苯胺蓝特殊染色、苏木素-伊红（hematoxylin-eosin,HE）染色和免疫组化方法分别对皮肤组织样品真皮肥大细胞、成纤维细胞和I型、III型胶原进行检测。结果：激光治疗后1h、1天、7天、21天和30天,治疗组真皮肥大细胞总数较正常对照组明显增高（均为P〈0.01）;激光治疗后1h、1天、7天、21天、30天和60天,治疗组真皮脱颗粒的肥大细胞数量较正常对照组均明显增高（分别为P〈0.01、P〈0.01、P〈0.01、P〈0.05、P〈0.01、P〈0.01）;激光治疗后7天、21天、30天和60天,治疗组真皮成纤维细胞数量较正常对照组明显增高（分别为P〈0.05、P〈0.01、P〈0.01、P〈0.01）;激光治疗后21天、30天、60天,治疗组真皮I型胶原水平较正常对照组明显增高（分别为P〈0.01）;激光治疗后7天、21天、30天和60天,治疗组真皮III型胶原水平较正常对照组明显增高（分别为P〈0.01、P〈0.05、P〈0.01、P〈0.01）。真皮脱颗粒的肥大细胞数量与真皮成纤维细胞数量呈显著正相关（r=0.663,P〈0.01）;真皮脱颗粒的肥大细胞数量与真皮I型及III型胶原水平亦分别呈显著正相关（分别为r=0.558,P〈0.01;r=0.630,P〈0.01）。结论：肥大细胞可能参与非剥脱性激光诱导的炎症反应、成纤维细胞增生和胶原重建。     

Treatment of Leg Vein Telangiectases: 1-Year Results With a New 940 nm Diode Laser

BACKGROUND: Short-term results obtained with a 940 nm diode laser indicate that this laser is effective in the treatment of leg vein telangiectasia. Long-term studies are needed to evaluate the definitive clinical end results. OBJECTIVE: To evaluate long-term results in the treatment of leg vein telangiectasia with a 940 nm diode laser and to compare these with short-term results. METHODS: Twenty patients were treated with 940 nm diode laser, 300-350 J/cm2, 40-70 msec, 1 mm spot, single pass. Photographs for evaluation of clearance were taken before treatment and 4 weeks and 12 months after the last treatment. RESULTS: At 12 months follow-up, clearing rates were greater than 75% in 15 patients (75%) and 50-75% in 5 patients. In 7 patients (35%) the clearing rate had improved considerably during follow-up. CONCLUSION: Definitive results with the 940 nm laser occur only after prolonged follow-up. They are considerably better than the short-term results.     

长脉宽1064nmNd：YAG激光治疗儿童皮肤血管瘤的疗效

目的探讨长脉宽1064nmNd：YAG激光治疗儿童皮肤血管瘤的疗效和不良反应。方法将207例血管瘤患者（164例为增生期,43例为静止期）分为两组：A组为皮损完全位于皮肤（142例）;B组为部分皮损位于皮下（65例）,使用长脉宽1064nmNd：YAG激光治疗。分别选择光斑直径2、6mm,能量50～90J／cm2和脉宽10、40、60ms进行治疗,治疗间歇期为1个月。结果207例经1～6次治疗后．两组总有效率均为100％。两组治疗有效率的差异无统计学意义（P〉0．05）。不良反应率为11．6％,均可以逐渐恢复。结论长脉宽1064nmNd：YAG激光治疗浅表型皮肤血管瘤疗效显著,不良反应少且短暂。