Atrophic and a Mixed Pattern of Acne Scars Improved With a 1320-nm Nd:YAG Laser

BACKGROUND: Acne scar correction remains a challenge to the dermatologic surgeon. With nonablative laser resurfacing, this correction is imputed to dermal collagen remodeling and acne scar reorganization. Although atrophic acne scars tend to respond to laser treatment, the deeper ice pick and boxcar scars tend to be laser resistant. OBJECTIVE: To investigate the treatment of atrophic and a mixed pattern of facial acne scars, we evaluated a 1320-nm Nd:YAG laser. Twelve subjects with atrophic facial acne scars (N=6) or a combination of atrophic and pitted, sclerotic, or boxcar scars (N=6) received three laser treatments. Physician and patient acne scar ratings were performed at baseline and at 6 months after the last treatment. Acne scars were rated with a 10-point severity scale. RESULTS: Mean acne scar improvement was 1.5 points on physician assessments (P=0.002) and 2.2 points on patient assessments (P=0.01). Acne scars were rated more severely by patients than by the physician at all intervals. There were no noted complications at 6 months. CONCLUSION: The 1320-nm Nd:YAG laser is a safe and effective nonablative modality for the improvement of atrophic and a mixed pattern of facial acne scars.     

Utilization of the 1320-nm Nd:YAG Laser for the Reduction of Photoaging of the Hands

BACKGROUND: Nonablative laser resurfacing has been shown to improve the appearance photoaged skin. Clinical improvement has been associated with dermal collagen remodeling. OBJECTIVE: The objective was to determine the efficacy of a 1320-nm Nd:YAG laser for the treatment of photoaging hands. METHODS: Seven patients with photoaged hands received six monthly treatments with a 1320-nm Nd:YAG laser. Improvement in skin smoothness was evaluated by objective and patient assessment using a 6-point improvement scale: 1=no improvement and 6=80% to 100% improvement. RESULTS: Mild to moderate improvement was achieved as determined by both objective and patient assessment. Mean improvement by objective assessment was 2.4 points. Objective improvement was noted in four of seven patients, and these patients demonstrated a mean improvement score of 3.5 points. The mean improvement by patient assessment was 3.1 points. CONCLUSION: This case series demonstrates that the 1320-nm Nd:YAG laser with cryogen cooling can be effective for rejuvenation of photoaged hands.     

Subcision and 1320-nm Nd:YAG Nonablative Laser Resurfacing for the Treatment of Acne Scars: A Simultaneous Split-Face Single Patient Trial

BACKGROUND: Many methods have been proposed for the treatment of acne scars with variable cosmetic results. Subcision has been successfully used, although complications often include a hyperpigmented and hypertrophic wound healing response. Nonablative skin resurfacing with a 1320-nm Nd:YAG laser has also been proposed; however, the results are generally inferior to those of more invasive modalities. OBJECTIVE: The objective was to improve on the results of 1320-nm Nd:YAG nonablative laser resurfacing by combining this treatment of acne scars with needle subcision. METHODS: A split-face trial was conducted in a patient with severe rolling and boxcar acne scars. One side of the face was treated with two sessions of subcision alone, spaced 6 weeks apart, whereas the other side was treated with two sessions of subcision spaced 6 weeks apart and 1320-nm Nd:YAG laser sessions every 2 weeks starting after the first subcision. At the conclusion of the split-face trial, the unlasered side was then treated with six biweekly sessions of 1320-nm Nd:YAG. RESULTS: Although the use of subcision resulted in an improvement of the patient's acne scars, the combination of subcision and nonablative laser resurfacing was superior in topography, pigmentation, and overall appearance of the acne scars. CONCLUSION: This case illustrates that dual treatment with subcision and 1320-nm Nd:YAG nonablative laser resurfacing is a well-tolerated and highly effective regimen for the improvement of facial acne scars, compared to subcision alone.     

Nonablative Acne Scar Reduction after a Series of Treatments with a Short-Pulsed 1,064-nm Neodymium:YAG Laser

BACKGROUND: Effective treatment of facial acne scarring presents a major challenge. Nonablative lasers and radiofrequency devices work by thermally stimulating dermal collagen remodeling, thereby softening acne scars in a minimally invasive fashion. One such laser, a 1,064-nm short-pulsed Nd:YAG, uses rapidly scanned low-energy infrared pulses to heat the dermis selectively through the normal dermal microvasculature. OBJECTIVE: In this pilot study, the safety and efficacy of a novel short-pulsed Nd:YAG laser were investigated for the treatment of moderate to severe facial acne scarring. MATERIALS AND METHODS: Nine of 10 enrolled patients with moderate to severe facial acne scarring received eight sequential 1,064-nm Nd:YAG treatments (laser parameters 14 J/cm2, 0.3 milliseconds, 5-mm spot size, 7-Hz pulse rate, 2,000 pulses per side of face). Patients were graded for the presence and severity of three scar morphologies: superficial (rolling), medium-depth (boxcar), and deep (ice pick). Outcome measures included blinded evaluation of before and after photographs by three physician observers (scar severity score) and patient self-assessment. RESULTS: Acne scarring improved in 100% of the nine patients completing the study. Scar severity scores improved by a mean of 29.36% (95% confidence interval, 16.93%-41.79%; p = .006); 89% of patients noted greater than 10% scar improvement. No treatment-related adverse events were seen. CONCLUSION: Our findings support the use of a short-pulsed, low-fluence 1,064-nm Nd:YAG laser as a safe, effective treatment for facial acne scarring. Scar improvement was noted in all treated subjects with minimal discomfort and no downtime. This protocol appears to be most effective at reducing scar depth and softening scar contours. A laser upgrade needed for the study was provided to the authors at a reduced price.     

Improvement of Atrophic Acne Scars with a 1,320 nm Nd:YAG Laser: Retrospective Study

Background. Facial acne scarring has been treated with multiple methods with varying degrees of improvement. Although the 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been widely used to improve photoaging, studies analyzing its effects on atrophic acne scarring are limited.
Objective. To evaluate the efficacy of a dynamic cryogen-cooled 1,320 nm Nd:YAG laser for the treatment of atrophic facial acne scars in a larger cohort of patients with long-term follow-up.
Methods. Twenty-nine patients (skin phototypes I–IV) with facial acne scarring received a mean of 5.5 (range 2–17) treatments with a 1,320 nm Nd:YAG laser. Objective physician assessment scores of improvement were determined by side-by-side comparison of preoperative and postoperative photographs at a range of 1 to 27 months (mean 10.4 months) postoperatively. Subjective patient self-assessment scores of improvement were also obtained.
Results. Acne scarring was significantly improved by both physician and patient assessment scores. Mean improvement was 2.8 (  p < .05  ) on a 0- to 4-point scale by physician assessment and 5.4 (  p < .05  ) on a 0- to 10-point scale by patient assessment. No significant complications were observed.
Conclusions. Nonablative laser skin resurfacing with a 1,320 nm Nd:YAG laser can effectively improve the appearance of facial acne scars with minimal adverse sequelae.     

532-nm Nd:YAG and 595-nm Pulsed Dye Laser Treatment of Leg Telangiectasia Using Ultralong Pulse Duration

BACKGROUND: Telangiectatic leg veins have been treated using lasers with variable success. OBJECTIVE: We aimed to examine the efficacy and tolerability of a 595-nm pulsed dye laser (PDL) and a 532-nm Nd:YAG laser using ultralong pulse duration to improve leg telangiectasias with a single treatment. METHODS: Ten subjects with leg telangiectasias up to 1.0 mm in diameter participated in the study. The telangiectatic patch was divided into two approximately equal adjacent areas. The first area was treated with a 532-nm Nd:YAG laser at a fluence of 20 J/cm2 and a pulse duration of 50 ms using a contact cooling device. The second area was treated with a 595-nm PDL at a fluence of 25 J/cm2 and a pulse duration of 40 ms using cryogen spray precooling. Each area was treated once only. Photographic evaluation was used for an assessment of response. RESULTS: Two of 10 subjects had less than 25%, 3 had 25% to 50%, 2 had 50% to 75%, and 3 had more than 75% improvement after single treatment with a 532-nm Nd:YAG laser. Similarly, 2 of 10 subjects had less than 25%, 2 had 25% to 50%, and 6 had 50% to 75% improvement with the 595-nm PDL. Hyperpigmentation occurred in one subject treated with the 532-nm Nd:YAG laser and two subjects treated with the 595-nm PDL. No blistering, crusting, hypopigmentation, or scarring were observed. CONCLUSION: Both lasers using ultralong pulse width improved leg telangiectasias after a single treatment with minimal adverse reactions.     

Use of 1,320 nm Nd:YAG laser for wrinkle reduction and the treatment of atrophic acne scarring in Asians

BACKGROUND AND OBJECTIVES: The role of 1,320 Nd:YAG in non-ablative skin rejuvenation in Asians is has not been established. Furthermore, no study has investigated the effectiveness of 1,320 Nd:YAG laser in the treatment of atrophic scarring in Asians. The objective of our study was to investigate the effectiveness of 1,320 Nd:YAG laser in wrinkle reduction and the treatment of atrophic acne scarring in Asians. STUDY DESIGN/MATERIALS AND METHODS: Twenty-seven female patients were included in the study: seven were treated for acne scarring and the others for wrinkle reduction. A 1,320 nm Nd:YAG laser (Cooltouch II, Roseville, CA) was used to treat both the cheeks and forehead for the patients with wrinkles, and both cheeks only for patients with atrophic acne scarring. All patients received treatment in the post-auricular areas. A spot size of 10 mm was used, and three passes were performed (two pre-cooling and one post-cooling). Patients were treated monthly for 6 months. All patients were subjectively assessed before and after their last treatment sessions using a structured questionnaire, and objectively assessed by the use of clinical photographs for by independent observers. A cutometer was used to assess viscoelasticity, and biopsies were taken at the post-auricular site for assessment by a pathologist. RESULTS: The overall degree of patients' satisfaction was rated as 4.9 (range 0-9.8) for wrinkle reduction and 4 (range 0-10) for acne scarring. In terms of objective assessment by independent observers, the degree of improvement was considered to be mild or no change in most cases. The independent pathologist who assessed the degree of improvement in terms of increased collagen production detected no change in 8 patients, mild improvement in 9, and moderate improvement in 10.There was also improvement in term of epidermal thickness in 13 cases. Assessment by viscoelasticity indicated a significant degree of improvement in most parameters in both groups of patients. Blistering occurred in five cases, all in the central facial areas, and post-inflammatory hyperpigmentation occurred in three cases. All cases of PIH resolved after the use of 4% hydroquinoine. There was no scarring or hypopigmentation. CONCLUSIONS: The 1,320 nm Nd:YAG laser is effective for wrinkle reduction and atrophic acne scar improvement, but to further enhance the clinical outcome a combination approach with another device such as IPL and a surgical technique such as subcision is necessary.     

Nonablative 1450-nm Diode Laser in the Treatment of Facial Atrophic Acne Scars in Type IV to V Asian Skin: A Prospective Clinical Study

BACKGROUND: There is presently little published data on the clinical effectiveness of nonablative lasers in the treatment of atrophic acne scars and the safety of their use in patients with darker skin types. OBJECTIVE: This study aims to determine the clinical effectiveness and safety of the nonablative 1450 nm diode laser with cryogen cooling spray in the treatment of facial atrophic acne scars in Type IV-V Asian skin. METHODS: This is a prospective non-comparative open study. 4 to 6 laser treatment sessions were performed on patients with atrophic acne scars. Final clinical assessment was performed 6 months after the last treatment. RESULTS: 57 patients were evaluated. Patient's self-assessment of scar improvement as compared with doctor's assessment was as follows: patients who completed 4 treatments (15.7% vs 6.6%), patients who completed 5 treatments (20% vs 7.9%) and patients those who completed 6 treatments (17.3% vs 5.0%). Main side effects were mild to moderate pain during the procedure, transient erythema, and hyperpigmentation which occurred in 39% of treated patients. CONCLUSION: The nonablative 1450 nm diode laser may be effective in achieving mild to moderate gradual clinical improvement in the treatment of facial atrophic acne scars. The procedure is associated with minimal downtime and is safe for use in darker skin types IV and V.     

3D in-vivo optical skin imaging for topographical quantitative assessment of non-ablative laser technology.

BACKGROUND: A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, a new noninvasive objective assessment is required to accurately assess the outcomes of these procedures. OBJECTIVE: The purpose of this study was to measure and objectively quantify facial skin using a novel, noninvasive, In-vivo method for assessing three-dimensional topography. This device was used to quantify the efficacy of five treatment sessions with the 1064 nm QS Nd:YAG laser for rhytides and acne scarring, for up to six months following laser treatment. METHODS: Two subjects undergoing facial rejuvenation procedures were analyzed before and after therapy using a 30-mm, three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin using a Digital Micromirror Device (DMD Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at three and six-month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to In-vivo acquisition. RESULTS: Skin roughness decreased by 11% from baseline after three treatment sessions in the wrinkles subject, while a 26% improvement of skin roughness was recorded by 3D In-vivo assessment six months following the fifth treatment session. The subject with acne scarring demonstrated a 33% decrease in roughness analysis after three treatment sessions by 3D In-vivo assessment. A 61% improvement in surface topography was recorded 3-months following the fifth treatment session, which was maintained at the 6-month follow-up. CONCLUSION: Three-dimensional In-vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines following multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. This imaging technique provided objective verification and technical understanding of nonablative laser technology. Wrinkle depth and skin roughness decreased at the three and six-month follow-up evaluations by 3D In-vivo assessment, indicating ongoing dermal collagen remodeling after the laser treatment protocol. Future applications may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.     

Nd：YAG激光和CO_2点阵激光治疗面部痤疮凹陷性瘢痕疗效比较分析

目的：比较CooltouchⅢ1320nm Nd：YAG激光和KL型10600nm CO2点阵激光治疗面部痤疮萎缩、凹陷性瘢痕的疗效及安全性。方法：痤疮萎缩、凹陷性瘢痕患者85例,采用CooltouchⅢ1320nmNd：YAG激光治疗35例,KL型10600nm CO2点阵激光治疗50例。治疗前后使用ECCA权重评分表对治疗部位进行评分,比较两种治疗方案的疗效差异。定量测量患者疼痛度、停工期及并发症发生比例,对比两种激光治疗的安全性。结果：CO2点阵激光治疗组治疗后ECCA评分平均降低17.4,CooltouchⅢ治疗组降低为13.1,两者差异有统计学意义（P〈0.05）。CO2点阵激光平均疼痛度、停工期及并发症发生率均大于CooltouchⅢ治疗组。结论：两种方法均可用于治疗痤疮后萎缩、凹陷性瘢痕,KL型10600nm点阵激光比CooltouchⅢ1320nm激光疗效更为显著,尤其对于重度痤疮凹陷性瘢痕患者,但患者疼痛感明显,停工期长,有一定持续性红斑和色素沉着的风险。后者治疗时疼痛感较轻微,停工期较短,未见明显色素沉着发生,但需要疗程相对长,疗效相对稍差。故患者可以根据自身需求选择治疗。     

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.     

Comparison of a 1,064 nm Laser and a 1,320 nm Laser for the Nonablative Treatment of Acne Scars

Background. There have been many reports of the use of nonablative lasers for the treatment of acne scars.
Objective. To evaluate the ability of the 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser to treat acne scars and compare it with that of the 1,320 nm Nd:YAG laser.
Methods. Twelve patients with Fitzpatrick skin types I to III were randomly selected to have half of the face or back treated with the Lyra 1,064 nm Nd:YAG laser (Laserscope Corporation, San Jose, CA, USA) and the other half with the CoolTouch II 1,320 nm Nd:YAG laser (ICN Pharmaceuticals, Inc., Costa Mesa, CA, USA). Three treatments at 4-week intervals were performed. Patients were evaluated by photographic and profilometric methods before and 6 months after the last treatment.
Results. Immediate changes included mild erythema with the 1,064 nm Nd:YAG laser and mild edema and erythema with the 1,320 nm Nd:YAG laser. No long-term adverse changes were seen with either laser system. Using the 1,320 nm system, 42% of the patients had 30 to 40% clinical improvement, 42% had 11 to 29%, and 16% had 10% or less. With the 1,064 nm system, 58% had 30 to 40% clinical improvement and 42% had 11 to 29%. Average improvement in acne scars evaluated by three independent observers was 22% with the 1,320 nm laser compared with 28% with the 1,064 nm laser. The subjects' own grading was 39% with the 1,320 nm laser compared with 37% for the 1,064 nm laser. Prolifometric studies demonstrated comparable improvement, with no statistical difference using either laser.
Conclusion. These data indicate that both the 1,064 nm laser and the 1,320 nm Nd:YAG laser are safe and effective systems for the nonablative treatment of acne scars, achieving similar improvement. There appears to be a greater response with the 1,064 nm laser system as assessed by the clinical investigators.     

1064-nm Nd:YAG皮秒点阵激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的临床比较

目的 探究1064-nm Nd:YAG皮秒点阵激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗 效与安全性。方法 选取2021年6月-2023年6月于我院激光科接受治疗的62例面部萎缩性痤疮瘢痕患者作 为研究对象,按照不同的治疗方法分为皮秒点阵激光组和CO2点阵激光组,各31例。皮秒点阵激光组给予 1064-nm Nd:YAG皮秒点阵激光治疗,CO2点阵激光组给予超脉冲CO2点阵激光治疗,比较两组ECCA权 重评分、疗效自评分、满意度评分及术后不良反应发生情况。结果 两组治疗后ECCA权重评分均较治疗 前降低（P ＜0.05）,且皮秒点阵激光组的ECCA权重评分高于CO2点阵激光组（P ＜0.05）;CO2点阵激光 组疗效自评分高于皮秒点阵激光组（P ＜0.05）;皮秒点阵激光组不良反应发生情况低于CO2点阵激光组 （P ＜0.05）;两组满意度比较,差异无统计学意义（P＞0.05）。结论 1064-nm Nd:YAG皮秒点阵激光与 超脉冲CO2点阵激光均能有效改善面部萎缩性痤疮瘢痕,超脉冲CO2点阵激光疗效更好,而皮秒点阵激光 不良反应发生情况更少。     

Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study

BACKGROUND Atrophic scars are dermal depressions caused by collagen damage most commonly occurring after inflammatory acne vulgaris. There are little published data regarding the effectiveness and safety of minimally invasive lasers in the treatment of atrophic acne scars in darker skin types.
OBJECTIVE The purpose was to evaluate the efficacy and safety of a low-fluence 2,940-nm erbium:YAG laser in the treatment of atrophic acne scars in Asian patients.
MATERIALS AND METHODS Nine patients aged 19 to 45 years with mild to moderate atrophic facial scars and Skin Types IV and V were treated with topical anesthesia and one to two passes with an erbium:YAG laser two times at 1-month intervals. Treatment parameters were 6-mm spot size, fluence of 400 mJ, pulse duration of 300 μs, and repetition rate of 2 Hz.
RESULTS At 2 months after the last treatment, mild to moderate clinical improvement was noted in all patients compared to baseline. Treatment was well tolerated. Side effects consisted of posttreatment erythema, peeling, and crusting, which resolved within 1 to 2 weeks. There was no postinflammatory hyper- or hypopigmentation, blistering, or hypertrophic scarring.
CONCLUSION Low-fluence erbium:YAG facial resurfacing was effective and safe in patients with mild to moderately severe atrophic acne scarring.     

Treatment of hypertrophic scars using a long-pulsed dye laser with cryogen-spray cooling

Hypertrophic scars are common and cause functional and psychologic morbidity. The conventional pulsed dye laser (585 nm) has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars, with improvement in scar texture, color, and pliability, with minimal side effects. This prospective study was performed to determine the effectiveness of the long-pulsed dye laser (595 nm) with cryogen-spray cooling device in the treatment of hypertrophic scars. Fifteen Asian patients with 22 hypertrophic scars were treated by the long-pulsed dye laser (595 nm) with cryogen-spray cooling device. In 5 patients, the scar area was divided into halves, one half of which was treated with the laser, whereas the other half was not treated and was used as a negative control. All patients received 2 treatments at 4-week intervals, and evaluations were done by photographic and clinical assessment and histologic evaluation before the treatment and 1 month after the last laser treatment. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. Symptoms such as pain, pruritus, and burning of the scar improved significantly. VGH scores improved in all treated sites, and there was a significant difference between the baseline and posttreatment scores, corresponding to an improvement of 51.4 +/- 14.7% (P < 0.01). Compared with the baseline, the mean percentage of scar flattening and erythema elimination was 40.7 +/- 20.7 and 65.3 +/- 25.5%, respectively (P < 0.01). The long-pulsed dye laser (595-nm) equipped with cryogen spray cooling device is an effective treatment of hypertrophic scars and can improve scar pliability and texture and decrease scar erythema and associated symptoms.     

Treatment of Atrophic Facial Acne Scars with a Dual-Mode Er:YAG Laser

BACKGROUND: Scar revision with CO2 and Er:YAG lasers has become popular in recent years. Reports on the newest (modulated, dual-mode) Er:YAG systems have been limited mostly to the treatment of photodamaged skin and rhytides. OBJECTIVE: To prospectively evaluate the efficacy and safety of a dual-mode 2940 nm Er:YAG laser for atrophic scar revision. METHODS: Twenty-five consecutive patients with moderate to severe atrophic facial acne scars received treatment with a dual-mode Er:YAG laser. Clinical assessments using a standard grading scale and photographic documentation were performed at 1, 3, 6, and 12 months postoperatively. Postoperative recovery was monitored and the rate of side effects and complications recorded. RESULTS: Average clinical grading scores reflected good to excellent response of atrophic scars to the dual-mode Er:YAG laser system. Side effects and complications were limited to transient hyperpigmentation and acne flare-ups. No hypopigmentation or scarring was seen. Prolonged erythema (longer than 1 month) was observed in 1 patient (4%). CONCLUSION: Dual-mode Er:YAG laser skin resurfacing is a safe and effective modality for the treatment of atrophic facial scarring.     

Evaluating the Efficacy of Treatment of Resistant Port-Wine Stains With Variable-Pulse 595-nm Pulsed Dye and 532-nm Nd:YAG Lasers

Background. Some port wine stains (PWSs), despite multiple treatments with the 585-nm 0.45-ms pulsed dye laser (PDL), fail to improve substantially.
Objective. To determine the efficacy and tolerability of variable pulse width 595-nm PDL and 532-nm Nd:YAG laser in the treatment of resistant PWS.
Methods. Twenty-two patients whose PWS failed to achieve more than 75% lightening after more than 15 treatments with the 585-nm 0.45-ms PDL were recruited. A homogenous patch of PWS was divided into five areas. Area 1 (control area) was treated with 585-nm, 0.45-ms PDL (fluence 7.5 J/cm²). Areas 2 and 3 were treated with 595-nm PDL at fluence 15 J/cm² (with cryogen spray cooling) and pulse durations of 1.5 and 10 ms, respectively. Areas 4 and 5 were treated with a 532-nm Nd:YAG laser at 2 ms, 7 J/cm² and 10 ms, 16 J/cm², respectively (with a contact cooling tip). The response was assessed by photographic evaluation.
Results. Three patients had further lightening in area 2, and two patients had further lightening in area 3. Each of three patients had further lightening in areas 4 and 5, respectively. One patient had further lightening in the control area.
Conclusion. In individual patients, it may be effective to treat resistant PWS with the variable-pulse width 595-nm PDL and the 532-nm Nd:YAG laser.     

中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后相关症状和审美评价的影响因素分析

目的:分析中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后患者出现相关症状(瘢痕遗留、色素沉着、局部红斑)的影响因素,了解人群中对中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后影响审美评价的相关因素。方法:回顾性分析在笔者医院皮肤科应用1064nm波长可调脉宽Nd∶YAG激光治疗的89例中重度痤疮患者的临床资料。选取100名外貌正常,具备完整审美能力的普通人作为评价者,根据李克特量表对患者形象进行评分。采用单因素分析和多元Logistic回归模型分析中重度痤疮激光治疗后相关症状和审美评价的影响因素。结果:单因素分析显示,年龄、性别、BMI、吸烟、皮肤类型、初发年龄、病程、发病部位、家族史、伴发病、蠕形螨、尘螨SPT、瘢痕体质均是中重度痤疮激光治疗后相关临床症状的影响因素(P<0.05)。评价者年龄、学历,患者年龄、BMI、皮肤类型、发病部位、瘢痕厚度和瘢痕柔软度是审美评价的影响因素(P<0.05)。多因素Logistic分析显示,性别、家族史、伴发病、蠕形螨及尘螨SPT是中重度痤疮激光治疗后相关症状的独立影响因素(P<0.05)。评价者年龄、患者BMI、皮肤类型和发病部位均是审美评价的独立影响因素(P<0.05)。结论:中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后相关症状与性别、家族史、伴发病、蠕形螨及尘螨SPT有关。中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后的审美评价与评价者年龄,患者BMI、皮肤类型和发病部位有关。     

Successful Treatment of a Chronic Atrophic Dog-Bite Scar with the 1450-nm Diode Laser

BACKGROUND: Atrophic scars can be revised with surgical methods and more recently with newer ablative and nonablative laser techniques. Nonablative laser technology offers the advantage of improving the appearance of atrophic scars without the risks associated with traditional surgery or ablative lasers. METHODS: A case of a large linear atrophic dog-bite scar on the chin of greater than 2-year duration treated for three sessions at 4- to 6-week intervals with the 1450-nm diode laser is presented. RESULTS: Fifty to seventy-five percent improvement in the appearance of the scar resulted after three treatments with the 1450-nm diode laser. No adverse effects were noted from the treatment. The patient subjective rating of scar improvement was more than 50%. CONCLUSION: The 1450-nm diode laser may provide a noninvasive and effective alternative for the treatment of atrophic traumatic scars. This method appears to be potentially effective even for treatment of very mature scars and warrants additional studies.     

Treatment of Pigmented Hypertrophic Scars with the 585 nm Pulsed Dye Laser and the 532 nm Frequency-Doubled Nd:YAG Laser in the Q-Switched and Variable Pulse Modes: A Comparative Study

BACKGROUND: Pigmented hypertrophic scars are a difficult condition to treat. They may result from traumatic injuries or from surgical and cosmetic procedures. The 585 nm flashlamp-pumped pulsed dye laser (FLPDL) has been used to treat this condition, with significant improvement of varying degrees. It remains to be determined whether other laser modalities may have a similar or even greater success in the treatment of pigmented hypertrophic scars. OBJECTIVE: To determine the efficacy of the 532 nm frequency-doubled Nd:YAG laser in the treatment of pigmented hypertrophic scars as compared to the 585 nm FLPDL. METHODS: Six patients with pigmented hypertrophic scars and skin phototypes II-IV were chosen. A scar was selected for treatment in each patient and divided into four equal 2 cm segments. Three segments were each treated with a different laser modality and one was left untreated to serve as the control. A 585 nm FLPDL was used with an energy of 3.5 J, a pulse duration of 450 microsec, and a 10 mm spot size. A 532 nm Q-switched frequency-doubled Nd:YAG laser was set to an energy of 2.8 J, a 10-nsec pulse, and a 3 mm spot size. The same 532 nm laser was set to the variable pulse mode to treat a 2 cm scar segment, with an energy of 9.5 J, a 10-msec pulse, and a 4 mm spot size. An average of 3.3 treatments were performed on each scar segment, at intervals of 4-6 weeks and long-term follow-up at 22 weeks. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. A SigmaStat t-test was used to determine the statistical significance of the values obtained. RESULTS: Treatment of pigmented hypertrophic scars with the 532 nm Q-switched Nd:YAG laser led to a significant improvement of 38% in the VGH scores when compared to baseline (P =.005). The 585 nm FLPDL also had a favorable effect on the scars, with an average improvement of 36.1% in the VGH scores. There was no significant difference noted between the outcome of treatment with either of these two lasers. Treatment with the 532 nm variable pulse Nd:YAG laser led to a 19% improvement in the VGH scores of scars, which did not differ significantly from the 16.1% improvement observed in control scars on the last follow-up visit. No side effects or complications from treatment were noted or reported during the course of the study. At the conclusion of the study, five of six patients chose the segment treated with the 532 nm Q-switched Nd:YAG laser as the best segment overall. CONCLUSION: The 532 nm Q-switched Nd:YAG laser and the 585 nm FLPDL offer comparable favorable results in the treatment of pigmented hypertrophic scars. The 532 nm Q-switched Nd:YAG laser may be preferred by patients particularly distressed by the dark color of their scars.