Superficial erbium:YAG laser resurfacing of photodamaged skin.

BACKGROUND: Light chemical peels and microdermabrasion have enjoyed recent popularity for the treatment of mild photoaging. However, clinical improvement from these modalities is often minimal from both a patient's and physician's perspective. Erbium:YAG lasers have been effective in treating mild to moderate photoaging, but the need for either regional or general anesthesia, as well as the significant post-treatment recovery period has limited its use. OBJECTIVE: We sought to utilize a very low fluence approach to erbium:YAG laser resurfacing, with topical anesthesia, to ascertain its efficacy in treating mild to moderate photoaging. METHODS: A total of 250 subjects aged 28-80 years with skin types 1-4 and mild to moderate facial rhytids were treated with topical anesthesia and subsequently one pass of a 2940 nm erbium:YAG laser, using between 5 and 17.5 J/cm2. In addition, 58 of the treated facial subjects underwent neck resurfacing with fluences between 5 and 15 J/cm2 and eight treated facial subjects underwent upper chest resurfacing at fluences of 5-7 J/cm2. A single treatment was received by 246 subjects; four subjects were treated a second time after a 1-month interval. RESULTS: Most subjects completely re-epithelialized by 3-4 days; healing time was depth dependent. Most subjects were able to start skin care regimens within 1-2 weeks after the procedure. Results were judged to be excellent in individuals with thin skin and good in subjects with thicker skin. CONCLUSIONS: One pass of low fluence erbium:YAG resurfacing, under topical anesthesia, was effective for the treatment of mild to moderate photoaging.     

High-fluence fractional treatment of photodamaged facial skin using a 2940 nm erbium:yttrium-aluminum-garnet laser

Abstract

Introduction: Fractional resurfacing with an Erbium:yttrium-aluminum-garnet (Er:YAG) 2940 nm laser is an increasingly popular option for the treatment of the signs of facial photoaging, which include wrinkles as well as pigmentation issues and unwanted textural changes. Fractional treatment has produced favorable clinical responses, but with less complications and shorter recovery times than traditional laser resurfacing. This study was conducted to evaluate a fractionated Er:YAG treatment regimen of 1–2 higher fluence sessions with a multiple-pass technique. Materials and methods: Eight subjects with moderate to severely photodamaged facial skin received one to two full-face laser treatments. Multiple-pass (MP) treatment results were evaluated in terms of procedure time, discomfort, social downtime and effectiveness. A photographic evaluation, subject improvement assessments and a subject satisfaction assessment were performed. Results: An investigator's photographic review showed a 26–75% improvement in the signs of overall photoaging. Subjects treated with the MP technique exhibited a relatively short 3–4 day downtime and ratings of mostly moderate discomfort with the use of topical anesthetic cream only. Subjects treated with higher fluences demonstrated the highest average improvement in specific features of photoaging. Two laser treatments resulted in substantially higher improvement scores than those received just one laser treatment.     

Laser skin resurfacing with a novel portable erbium:YAG laser

Background and objective. The erbium:YAG laser is a popular modality for laser skin resurfacing (LSR). This study was performed to evaluate the safety and efficacy of a new portable Er:YAG laser in the treatment of photo‐damaged skin.

Methods. Nine patients with skin types I–III were treated for rhytides, large pores, pigmented lesions, lentigines and photo‐damage. Small facial areas such as the periorbital area, nose, cheeks, and upper lip were treated with one to six passes at 5–6 J/cm² with a new portable Er:YAG laser. Topical and local anesthesia was used.

Results. All treated areas showed improvement and, depending upon the number of passes, re‐epithelialization was complete within 2–7 days. The intense erythema resolved within 7 days and there was blending of treated and untreated areas within 2 weeks.

Conclusion. The technique of applying a tailored number of 5–6 J/cm², 300 µs pulses of a new portable Er:YAG laser to small areas appears to be safe and effective. There was minimal discomfort and a high level of patient satisfaction after a relatively short recovery time.     

Erbium:YAG laser resurfacing in patients with inflamed cystic acne

Background: Inflammatory cystic acne has been treated by a variety of modalities including antibiotics, topical agents, isotretinoin and chemical peels with variable degrees of success. Erbium:YAG lasers have been used for the treatment of acne scarring and photoaged skin but have not been thought of as treatment for actively inflamed lesions. Objective: We sought to ascertain the effectiveness of using low fluence erbium:YAG settings without topical anesthesia for the treatment of two patients with inflamed cystic acne. Methods: Two female patients with type 4 skin of Hispanic (32 years old) and south Asian (21 years old) origin were treated with the 2940 erbium:YAG LaserPeel laser. The Hispanic patient was treated twice with a 2‐month interval between treatments using the 200 mJ setting. The Asian patient had a combination of 200 and 400 mJ settings for her first treatment and 400 mJ for the subsequent two treatments. She was treated three times with an interval of 1 month between the first two treatments and a 2‐month interval between the second and third treatments. Results: Both patients healed within 6 days of each treatment and demonstrated progressive improvement. Results were excellent in both. Conclusion: Low fluence erbium:YAG facial resurfacing was effective for the treatment of inflamed cystic acne. Its use as a treatment modality should be further explored.     

Cutaneous photoaging treated with a combined 595/1064 nm laser

Background and objectives: The pulsed dye laser (PDL) has been used for a variety of vascular changes associated with photoaging. The Nd:YAG laser has been shown to be effective in the treatment of deeper facial vessels, as well as to stimulate new dermal collagen deposition. This study was undertaken to evaluate the safety and efficacy of sequential dual‐wavelength PDL and Nd:YAG laser treatment of photoaged facial skin. Methods: Fifteen individuals, between the ages of 38 and 66 years old, with various stigmata of facial photoaging, were entered into the study. Five sequential combined PDL/Nd:YAG (Cynergy, Cynosure Inc., Westford, MA, USA) treatments were performed using a 10‐mm handpiece at monthly intervals. PDL parameters included a 10‐ms pulse duration and a fluence set at 1?J/cm² below the purpura threshold. Nd:YAG parameters were set at a 50‐ms pulse duration with fluences varying between 35 and 50?J/cm², depending on patient comfort. Improvement was determined by evaluation of photographs taken before the first treatment and at 1 and 3 months following the last treatment, as well as the individual's self‐assessment. Results: Individuals tolerated treatments well with no serious, long‐term, or permanent adverse effects. Improvement was most pronounced in telangiectasias and diffuse erythema, followed by epidermal dyspigmentation and lentigines. Some individuals were also noted to have improved smoothness, radiance, or pore size. The improvement was generally maintained at the 3‐month follow‐up. In addition, the average self‐reported improvement was 1.7 (on a 0–4 scale) at 1 month and 2.4 at 3 months following the last treatment. Conclusion: A novel combined sequential PDL/Nd:YAG laser can be used to treat a variety of cutaneous changes associated with photoaging. Further studies may determine the relative impact of each laser and whether the total effect is simply additive or synergistic.     

Erbium:YAG laser skin resurfacing: a Pakistani experience

BACKGROUND AND OBJECTIVES: To evaluate the use of the erbium:YAG laser for resurfacing in type IV skin patients in Pakistan.

STUDY DESIGN/MATERIALS AND METHODS: Ten patients with skin type IV underwent laser skin resurfacing with an erbium:YAG laser to treat wrinkles, acne/chickenpox scars and hyperpigmentation. An evaluation was done by the treating physician and a photographic evaluation and grading was done by a blinded observer.

RESULTS: The treating physician's records show no erythema, pigmentary alteration, infection or scarring at the 3‐month follow‐up. The blinded observer's evaluation of the 3‐month photographs showed moderate to excellent improvement in 80% of patients in their respective underlying condition.

CONCLUSION: The erbium:YAG laser is safe and effective in treating wrinkles, acne/chickenpox scars and hyperpigmentation in skin type IV patients.     

Penetration enhancement of two topical 5‐aminolaevulinic acid formulations for photodynamic therapy by erbium:YAG laser ablation of the stratum corneum: continuous versus fractional ablation

Please cite this paper as: Penetration enhancement of two topical 5‐aminolaevulinic acid formulations for photodynamic therapy by erbium:YAG laser ablation of the stratum corneum: continuous versus fractional ablation. Experimental Dermatology 2010; 19 : 806–812. Abstract: 5‐Aminolaevulinic acid (ALA) is used in photodynamic therapy (PDT). Response rates of PDT vary widely, which may be because of the limited uptake of topically applied photosensitisers. We investigated skin penetration and fluorescence induction of protoporphyrin IX (PpIX) after applying either 20% ALA cream or 20% aminolaevulinic acid solution on laser‐stripped stratum corneum (SC) in an ex vivo full‐thickness porcine skin model. Both formulations are used in clinical practice. To enhance the skin penetration of ALA, we used two different 2940‐nm erbium:yttrium–aluminium–garnet (Er:YAG) laser systems to partially ablate the SC: continuous and fractional ablation. Different fluences were applied ranging from 0.5 to 1.5 J/cm² (continuous ablation) and from 4 to 24 J/cm² (fractional ablation). Fluorescence microscopy was used for detecting PpIX‐induced fluorescence. Compared to skin without laser pretreatment, mean fluorescence intensity (MFI) of PpIX was enhanced 13.8‐fold after continuous ablation with 1.0 J/cm² and 7.3‐fold after fractional ablation with 4 J/cm²; each laser procedure was followed by 4‐h incubation with lipophilic ALA cream. Optimal parameters for continuous ablation without damage to the epidermis were 1 J/cm² for both formulations, fractional ablation was best with 4 J/cm². Histological evaluations of laser‐treated skin showed necrosis and apoptosis, depending on light dose. In laser‐stripped skin, PpIX fluorescence was detected earlier and reached deeper epidermal layers than in untreated skin. Continuous laser ablation induced higher PpIX fluorescence levels than fractional ablation. This method offers a promising new tool for enhancing ALA penetration in PDT without damaging the underlying tissue.     

A study of multiple full-face treatments with low-energy settings of a 2940-nm Er:YAG fractionated laser

Abstract

Background and objective: Fractional Er:YAG 2940-nm laser resurfacing is a relatively new approach to the treatment of photodamaged skin. Typically, this approach uses fairly high delivered energies in order to create ‘microscopic wounds’ of tissue coagulation at various dermal depths. The purpose of this study was to evaluate the efficacy, safety and tolerability of low-energy, multiple-treatment, fractional Er:YAG laser resurfacing for the treatment of photoaged skin. Methods: Sixteen subjects with photoaged skin received six, lower-fluence laser treatments with a 2940-nm wavelength Er:YAG laser, using a fractionated handpiece and a maximum energy of 30 mJ per micro-spot. Subject satisfaction, treatment tolerability, and subject outcome assessment were performed. Results: Of the 12 subjects who completed the trial, all recorded improvement in their treated skin; half reported over 50% improvement. Most patients reported none or only mild stinging and burning during and after treatment. There was no downtime associated with the procedure. No adverse events were reported. Patient satisfaction rates were high. Conclusion: Low-energy, multiple treatment, 2940-nm Er:YAG laser resurfacing with this novel device is a safe and well-tolerated method for the treatment of superficial to moderate photoaged skin.     

The effects of a high glycerin content hydrogel premolded mask dressing on post-laser resurfacing wounds

Abstract

Background: Laser resurfacing for the rejuvenation of facial skin remains a popular cosmetic procedure. Postoperative care for laser resurfacing is important to optimize healing, reduce pain and minimize complications. Objective: To compare the efficacy of the new dressing against placebo (Vaseline^® cream) after Er:YAG laser resurfacing. Methods: Fifteen patients between 45 and 72 years of age with facial wrinkles were enrolled in the study. Patients underwent full-face Er:YAG procedures. The wounds were then dressed: one side of the face was treated with Vaseline and the other with a hydrogel dressing. Erythema, edema, pigmentation, average time of re-epithelization, pain score, itching, clinical evaluation of infection, crust formation and acidity were documented. Results: The hydrogel dressing decreased postoperative morbidity. The site treated by hydrogel showed a shorter epithelial healing time than the Vaseline site. The dressing relieved the immediate pain of facial resurfacing as well as preventing crust formation and itching. Conclusion: A hydrogel dressing is a better and suitable alternative to the open technique to manage post-laser wound healing.     

Er:YAG laser followed by topical podophyllotoxin for hard‐to‐treat palmoplantar warts

BACKGROUND AND OBJECTIVES: Palmoplantar warts are often hard to treat. They tend to relapse and the course of therapy is frustrating in many cases. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94?μm is capable of achieving a rapid and precise ablation of warts, but about 14% of patients are non‐responders as shown in a previous study. Podophyllotoxin is an established antimitotic agent derived from podophyllum plant resin, approved for human papilloma virus (HPV)‐induced genital warts. The combination of both ablative Er:YAG laser and topical 0.5% podophyllotoxin solution in hard‐to‐treat palmoplantar HPV warts was investigated.

PATIENTS AND METHODS: Thirty‐five patients with hard‐to‐treat warts (palmar or plantar) with a mean age of (32.2±12.1) years, range 17–50 years, with various pretreatments that had failed, were treated once by Er:YAG laser ablation with a spot size of 3?mm, a frequency between 8?Hz and 10?Hz, and a fluence of 5.7–11.3?J/cm². After wound healing, topical podophyllotoxin 0.5% solution was applied for 3 days followed by a break of 4 days. Four to six treatment cycles with podophyllotoxin were performed.

RESULTS: After laser treatment followed by topical podophyllotoxin cream a complete response was observed in 31 patients (88.6%). Two patients with plantar warts and a complete response showed a relapse within 3 months after treatment (5.7%). None of the patients developed pigmentary changes, wound infections or scarring.

CONCLUSION: The therapy of hard‐to‐treat warts with a combination of Er:YAG laser and topical podophyllotoxin is safe and effective. Compared with laser alone, the CR percentage seems to be higher and the percentage of relapses reduced.     

Digital ultraviolet reflectance photography can be used to quantify improvements in photodamage

Objective Increasing attention has focused on the treatment and reversal of ultraviolet‐ induced photodamage. This study was designed to determine whether ultraviolet reflectance photography could quantify the clinical effects of erbium:YAG laser resurfacing on photoaged skin. Methods Twenty patients (ages 46–67) with moderate to severe photodamage underwent dual‐mode variable pulsed erbium:YAG laser facial resurfacing. Pretreatment and post‐treatment evaluations at 3 and 6 months were performed clinically and photographically with white and ultraviolet reflectance photography. Results Image conversion of the ultraviolet reflectance imaging data demonstrated an average of 36% and 42% reduction in photodamage at 3 and 6 months, respectively. This correlated well with the wrinkle reduction and correction of dyspigmentation observed in all patients following laser resurfacing. Histologic examination confirmed a thicker, more orderly epidermis and dermal collagen remodeling after treatment. Conclusion Reduction in photodamage using the dual‐mode variable pulsed erbium:YAG laser can be quantitatively measured with ultraviolet reflectance photography using digital imaging. This model should prove useful in developing treatment regimens for photodamage.     

Pain inhibition in Q‐switched laser tattoo removal with pneumatic skin flattening (PSF): A pilot study

Background: Tattoo removal with a Q‐switched laser is often a painful procedure. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia to the treated area of the skin is time‐consuming, with only very moderate pain relief. Objective: To determine the efficacy of pneumatic skin‐flattening (PSF) technology which utilizes an evacuation chamber that generates skin compression and activates tactile neural receptors in the skin, resulting in afferent inhibition of pain transmission in the dorsal horn (the ‘gate theory’). Methods: Eleven young patients aged 17–25 years old (nine females, two males) who were treated for tattoo removal were enrolled in the study. The patients were treated by a Q‐switched Nd:YAG laser. Acute pain evaluation was performed on all 11 patients: one to two sites per patient with PSF and one to two control sites without PSF. When patients were treated with PSF, they knew they were being treated with a device that might reduce pain. This may have influenced patients' perception of pain. The evaluation was based on a modified McGill pain questionnaire. Results: All 11 patients completed the study. A lower pain score with PSF was observed in all but one patient (10/11 or 91%). The average reduction of pain is by two levels: from very painful to very mild pain. The energy transmission of the PSF window is 95%, resulting in essentially identical efficacy of the PSF treatment and the regular non‐PSF treatment. Conclusion: This pilot study indicates that PSF technology may reduce pain in tattoo removal with medium energy density Q‐switched lasers (3–5?J/cm²).     

The lamellar peel: A sequential nonablative and ablative laser treatment for facial skin rejuvenation

Objectives. Ablative and nonablative laser treatments have established themselves independently in the rejuvenation of aging skin. This study was designed to determine the effects of sequential nonablative and ablative laser treatments on facial skin.

Materials and methods. Twelve patients, ages 32–56 years, with skin phototypes I‐IV, received three treatments spaced six weeks apart. Each treatment consisted of one pass with 1319‐nm Nd:YAG laser at 16 J/cm², 50 ms pulse duration. This was immediately followed by one pass of 2940‐nm Er:YAG laser at 5 J/cm². Photographs and biopsies were taken prior to the first treatment and following the third treatment.

Results. Clinical improvements in facial skin tone and texture, acne scarring and dyschromia were noted in all patients. Histologic changes included a more compact epidermal granular layer and lamellar collagen formation with decreased solar elastosis in the dermis. Compared to controls, treated skin had a thicker, more homogeneous papillary dermis.

Conclusion. The sequential use of nonablative and superficial ablative laser treatments clinically and histologically improved photodamaged and chronologically aged skin. This occurred with minimal recovery and little morbidity, demonstrating this laser application to be a safe and effective method for facial rejuvenation.     

Histological hair removal study by ruby or alexandrite laser with comparative study on the effects of wavelength and fluence

BACKGROUND: Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences.

METHODS: Unwanted hairs were treated with a ruby laser (Chromos 694, ICN PhotonIcs, UK) at 10, 14 or 18?J/cm² or with an alexandrite laser (LPIR, Cynosure, USA) at 11, 14 or 17?J/cm². A 3?mm skin punch biopsy was taken immediately after each laser exposure and also 1 month later. Specimens were stained for histological observation. They were observed using immunohistochemistry with antibodies recognizing factor VIII related antigen or PCNA, and also by the TUNEL method. Similarly, electron microscopic observation was examined.

RESULTS: Immediately after the laser exposure, moderate follicular damage was observed following treatment with either type of laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either type of laser. A similar fluence with either laser treatment resulted in similar histological changes.

CONCLUSION: In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence are similar.     

A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation

Background. The use of visible or near infrared spectral light alone for the purpose of skin rejuvenation has been previously reported. A method of light emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths and thus compounding their distinct stimulation of cellular components is proposed.

Objective. To assess the efficacy and local tolerability of combination light therapy in photo rejuvenation of facial skin.

Methods. Thirty‐one subjects with facial rhytids received nine light therapy treatments using the Omnilux^TM LED system. The treatments combined wavelengths of 633 nm and 830 nm with fluences of 126 J/cm² and 66 J/cm² respectively. Improvements to the skin surface were evaluated at weeks 9 and 12 by profilometry performed on periorbital casts. Additional outcome measures included assessments of clinical photography and patient satisfaction scores.

Results. Key profilometry results Sq, Sa, Sp and St showed significant differences at week 12 follow‐up; 52% of subjects showed a 25%–50% improvement in photoaging scores by week 12; 81% of subjects reported a significant improvement in periorbital wrinkles on completion of follow‐up.

Conclusion. Omnilux^TM combination red and near infrared LED therapy represents an effective and acceptable method of photo rejuvenation. Further study to optimize the parameters of treatment is required.     

Ablative erbium:YAG laser treatment of idiopathic chronic inflammatory non-cicatricial balanoposthitis (Zoon's disease) – A series of 20 patients with long-term outcome

Abstract

Background: Chronic inflammatory non-cicatricial balanitis/balanoposthitis (Zoon 1952) is not uncommon among aged uncircumcised males. The course is chronic and will lead to severe epidermal atrophy. This disease is poorly responsive to topical treatment. The golden standard for treatment is circumcision. Objective: This study was performed to evaluate the efficacy and safety of ablative erbium:YAG laser treatment. Methods: An uncontrolled trial was performed with 20 Caucasian male patients (mean age 64.8 years) who presented with chronic inflammatory non-cicatricial balanitis or balanoposthitis. The patients received multiple topical treatments. The disease duration ranged from 1 to more than 7 years. Diagnosis was confirmed by histology. Topical anaesthesia was performed before erbium:YAG laser ablation (focus 1.6–5 mm; frequency 8 Hz; impulse energy mostly 800 mJ; fluence between 11.3 and 20 J cm^?2). The pulses were partly overlapping. The pain sensation was recorded by visual analogue scale (VAS). Complete clearance was defined as complete absence of erythematous, smooth-faced, ‘wet’-looking patches or erosions. Patients were requested to attend a regular follow-up once a year. The outcome was further assessed by patient's global assessment (PGA). Results: In all patients a complete re-epithelialization could be achieved within 2–3 weeks. During follow-up between 3 months and 30 months (mean 12.1 ± 7.2 months), a complete and stable clearing was achieved in 20 patients (100%). There were no severe adverse effects. With topical anaesthetic cream the VAS was very low (mean 1.5 ± 4.1 mm for 18 patients and 22 treatments). All but three patients were ‘completely satisfied’ with the procedure and the outcome; three were ‘satisfied’. Conclusions: Ablative erbium:YAG laser therapy is a safe, effective and minimally invasive treatment option in chronic inflammatory non-cicatricial balanitis/balanoposthitis.     

Treatment of angiokeratoma of Mibelli alone or in combination with pulsed dye laser and long‐pulsed Nd: YAG laser

Treatment of angiokeratoma of Mibelli is usually challenging because of the location, the pathogenetic condition and the cosmetic requirements. We present our characteristic treatment with the application of pulsed dye laser PDL and lpNd:YAG laser. All of these lesions were treated by topical anesthesia with Emla. Combined dual PDL‐lpNd:YAG (PDL: 595 nm, 5 mm/7 mm, 0.5 ms, 8–10 J/cm²; lpNd:YAG: 3 mm/5 mm, 15 ms, 90–120 J/cm²) treatment was used to treat lesions which with moderate to severe hyperkeratosis and hyperplasia. To the maculopapule ones, the energy density of lpNd:YAG might upgrade to 150 J/cm². Singular PDL (595 nm, 5 mm/7 mm, 0.5 ms, 9–12 J/cm²) treatment was used to treat lesions which with slight hyperkeratosis and hyperplasia. Continuous airflow cooling was always applied during the laser treatment. The treatment interval was 6–12 weeks. Of the 5 patients, 3 of them were cured and 2 of them were improved. All of them were satisfied with the cosmetic results. We recommended the combined dual PDL‐lpNd:YAG laser in treating severe hyperkeratotic and hyperplastic angiokeratoma of Mibelli. It can aid in achieving a desirable outcome whilst also reducing the required treatment sessions. However, most patients felt painful during the operation and experienced a severe long term recovery time after operation.     

A fractional 2940 nm short-pulsed,erbium-doped yttrium aluminium garnet laser is effective and minimally invasive for the treatment of photodamaged skin in Asians

Abstract

Background: Although ablative fractional laser for the facial photodamaged skin was effective and safe, there have been only limited reports regarding the efficacy and safety of fractional Er:YAG laser treatments for photodamaged facial skin in Asians. Objective: Our objective was to assess the efficacy and safety of the Er:YAG laser (2940 nm) using the ‘‘ablative’’ fractional resurfacing mode to treat photodamaged facial skin. Methods: A total of 29 Korean patients were treated for photodamaged facial skin using a fractional Er:YAG laser. The number of treatments was mean 2.3 sessions at two-week intervals. Independent investigators assessed the efficacy using standardized photographs. The patients’ satisfaction rate was also evaluated. Results: For dyspigmentation, 62.5% of the treated patients showed improvement greater than 26%. Regarding wrinkles, 50% of the treated patients showed improvement greater than 26%. All patients showed various degrees of improvement in skin laxity. Assessing the overall features, 62.5% of the study subjects showed improvement greater than 26%, and most of them (91.7%) reported that their subjective satisfaction rate was above ‘slight satisfaction’. Downtime accounted for approximately one week in most patients. Conclusions: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for photodamaged facial skin in Asians.     

Multiple minimally invasive Erbium: Yttrium Aluminum Garnet laser mini-peels for skin rejuvenation: an objective assessment

Background As the demand for minimally invasive rejuvenation is increasing, micropeel resurfacing using Erbium:Yttrium Aluminum Garnet (Er:YAG) laser 2940 nm has been reported for the treatment of photoaged skin without ablation of the epidermis. However, little is known about the efficacy and underlying histologic changes associated with this type of treatment. Aims The aims of this study are to evaluate the clinical effect and objectively quantify the histological changes in response to multiple sessions of Er:YAG laser 2940 nm mini‐peels. Patients and methods Six female volunteers of Fitzpatrick skin type III–IV and Glogau’s class I–III wrinkles were subjected to six microresurfacing peels at 2‐week intervals using Er:YAG 2940 nm laser at subablative fluences of 2–3 J/cm² to treat periorbital rhytides. Quantitative evaluation of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin was performed by histochemistry and immunohistochemistry coupled with computerized morphometric analysis at base line, end of treatment, and 3 months post‐treatment. Results Compared to the base line, evaluation of volunteers revealed obvious clinical improvement in response to Er:YAG mini‐peels. Collagen types I, III, and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased in response to treatment. However, this was followed by regression of improvement at 3 months post‐treatment but was still better than baseline. Conclusions This study revealed that multiple Er:YAG mini‐peels is a promising treatment option for photoaging as it reverses the signs of photoaged skin with little downtime and side effects. However, to maintain the short‐term improvement achieved after treatment, continued Er:YAG 2940 nm laser mini‐peels is required.     

A systematic review of comparative studies of CO2 and erbium:YAG lasers in resurfacing facial rhytides (wrinkles)

Background: Laser resurfacing is used to minimize wrinkles, solar scars and sequelae of acne. Objective: Purpose of the systematic review was to compare resurfacing outcomes of CO₂ laser and erbium: yttrium aluminium garnet (erb:YAG) laser therapies. Materials and methods: Medline, Cochrane Library, EMBASE and Google Scholar databases were searched until 9 April 2015 using the following terms: laser, carbon dioxide/CO₂, facial wrinkles, rhytides and erbium-doped yttrium aluminium garnet/erbium:YAG/Er:YAG. Two-armed controlled split faced studies that compared CO₂ laser and erbium:YAG laser in patients with mild-to-moderate facial wrinkles or rhytides were included. Results: The pooled data in this study and findings of other studies support the greater efficacy with the CO₂ laser in improving facial wrinkles, but the erb:YAG laser was associated with a better complication profile compared with the CO₂ laser. Except one case of hypopigmentation, other complications (i.e., erythema, hyperpigmentation and crusting) and their rates were reported by studies examining both lasers. Conclusion: In general, the CO₂ laser appeared to be more efficacious then the erb:YAG laser in treating facial wrinkles. Both lasers treatments were well tolerated.