Photorejuvenation using long-pulsed alexandrite and long-pulsed neodymium:yttrium-aluminum-garnet lasers: a pilot study of clinical outcome and patients' satisfaction in Koreans

Long-pulsed 755-nm alexandrite and long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers have been used for photorejuvenation of the face. The aim of this study was to investigate the safety and efficacy of long-pulsed alexandrite and long-pulsed Nd:YAG lasers for photorejuvenation in Korea. One hundred and sixteen Korean patients with photo-aged facial skin were enrolled. Sixty-two patients with facial pigmentation underwent long-pulsed alexandrite laser treatment. Eleven patients that wanted to improve facial pigmentation with minimal pain had quasi-long-pulsed alexandrite laser treatment. Forty three patients had long-pulsed Nd:YAG laser therapy. Outcome assessments included standard photographs and global evaluation by blinded investigators. The self-assessment grade was provided in questionnaires. Forty-four percent of patients reported excellent or good improvement of their pigmentary lesions (>50% improvement) using a long-pulsed alexandrite laser. Of patients who underwent long-pulsed Nd:YAG laser treatment, 36% reported excellent or good improvement in skin tightening, 50% in facial flushing and 45% in pigmentary lesions. We conclude that long-pulsed alexandrite and long-pulsed Nd:YAG lasers are safe and effective for facial photorejuvenation in Koreans.     

308-nm准分子激光联合他克莫司软膏治疗面部白癜风656例疗效评价

目的：评价308nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效。方法：对656例面部白癜风患者照射308nm准分子激光联合外用他克莫司软膏。他克莫司软膏每日2次,308nm准分子激光每周治疗1-2次,共治疗30次。末次治疗后随访1年。结果：1630块白斑中,总有效率为47.12%,病程<2年皮损总有效率为58.10%高于病程≥2年皮损的16.60%,两组差异具有统计学意义(P<0.001)。眼周皮损疗效最佳,总有效率为54.96%,口周皮损疗效最差,总有效率为40.22%,差异有统计学意义（P<0.0001）。结论：308 nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效与病期和皮损部位有关。     

Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: Six‐year experience with 333 patients

Lasers and other light sources are popular treatment options for facial rejuvenation in recent years. In this study, we aimed to compare the efficacy and safety of fractional radiofrequency (RF) and fractional Erbium: YAG (Er:YAG) laser for facial and neck skin wrinkles, objectively. Three hundred and thirty‐three patients treated with fractional RF and fractional Er:YAG laser were evaluated by two blinded dermatologists. Fractional Er:YAG laser was more effective for the periorbital area; whereas fractional RF treatment was more effective for perioral, nasolabial and jawline areas. There was no statistically significant difference in side effects between two treatment groups. In conclusion, both modalities significantly improve skin wrinkles; however, it should be considered that there may be regional differences between the treatment outcomes of them.     

超脉冲CO_2点阵激光与微针治疗面部痤疮凹陷性瘢痕的疗效对比

目的探讨超脉冲CO_2点阵激光与微针对面部痤疮凹陷性瘢痕的临床疗效。方法选取120例痤疮凹陷性瘢痕患者,随机数字表法分为2组,观察组患者(60例)给予超脉冲CO_2点阵激光治疗,对照组患者(60例)给予微针治疗,观察并记录2组患者临床疗效,治疗前后的视觉模拟评分(VAS)评分及治疗期间不良反应情况,评价超脉冲CO_2点阵激光对面部痤疮凹陷性瘢痕的临床疗效。结果治疗前,2组患者VAS评分差异无统计学意义(P0.05);治疗后,2组温哥华瘢痕量表(VSS)评分均明显降低(P0.05)。与对照组相比,2组VAS评分差异无统计学意义(P0.05)。与对照组相比,观察组治疗有效率较高(P0.05),且观察组治疗总费用明显高于对照组(P0.05),治疗期间,观察组不良反应率发生率高于对照组(P0.05)。结论超脉冲CO_2点阵激光和微针治疗均对痤疮凹陷性瘢痕具有较好的治疗效果,超脉冲CO_2点阵激光疗效更佳,但治疗后不良反应较多,需提前预防,相比之下,微针治疗不良反应较低。     

Facial scars after a road accident: Combined treatment with PDL and Q‐switched ND:YAG laser

We report the case of a woman who presented with several facial scars following a road accident. Treatment was carried out using combined laser treatment with pulsed dye laser (PDL) and the Q‐switched neodymium:yttrium‐aluminum‐garnet laser (QS Nd:YAG laser). No side effects or complications from treatment were noted or reported. The patient had very good cosmetic results with this combined technique. A variety of facial scars – erythematous, pigmented, atrophic and hypertrophic – may occur as a result of trauma, surgery, burns and skin disease. Surgery with other adjunctive methods including radiotherapy, intralesional steroids and pressure therapy has shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The PDL is the optimal treatment for reducing scar bulk and symptoms. It also decreases the erythema and telangiectasia associated with scars, normalizes the skin surface texture and improves scar pliability. The QS Nd:YAG laser (1064?nm) is highly effective for traumatic tattoo removal, resulting in complete clearance in the majority of cases.     

308 nm准分子激光联合吡美莫司乳膏治疗儿童白癜风的疗效观察

目的 评价308 nm准分子激光联合吡美莫司乳膏治疗儿童白癜风的疗效及不良反应。 方法 随机选取49例皮损对称的稳定期儿童白癜风患者，采用自身对照方法，将对称的皮损随机分成A、B两组，A组：给予准分子激光照射，每周2次，疗程15周，联合外用吡美莫司乳膏，每日2次；B组：单独给予准分子激光照射，每周2次，疗程15周。分别于准分子激光治疗第15次及30次后进行疗效评价。结果 30次治疗结束后，A组显效率为77.1%，有效率为89.6%，B组显效率为52．1%，有效率为75.0%，A组有效率及显效率均显著优于B组（P ＝ 0.048，P ＝ 0.040）。两组不同部位皮损疗效比较，仅面部皮损予以联合治疗后显效率及有效率显著优于单用准分子激光治疗（P = 0.004）。结论 308 nm准分子激光对儿童白癜风是一项安全、有效的治疗方法，联合应用吡美莫司乳膏能增加面部皮损疗效。     

Efficacy of a new fractional CO2 laser in the treatment of photodamage and acne scarring

This study evaluates the efficacy and safety of a novel fractional CO₂ laser device for improving facial rhytids, hyperpigmentation, enlarged pores, skin laxity, and acne scarring. Subjects (n= 15) were treated three to five times at 3‐week intervals. Biopsy specimens were used to evaluate healing response and neocollagenesis. Clinical improvement was rated on a quartile rating scale from digital photographs. Subject discomfort during treatment was evaluated on a scale of 0 to 5. Fourteen subjects who completed the study achieved good to excellent improvement in overall appearance, with 60% rated excellent. Improvement in photodamage was good to excellent in 92% of subjects, and reduction in rhytids was good to excellent in 85%. A total of 79% of subjects achieved good to excellent improvement in pore sizes and skin laxity. Subject discomfort during treatment was 3.0 ± 0.7. Erythema persisted for 2–3 days, and subjects resumed normal activities 1–2 days after the procedure. Histological slides after a single treatment showed new collagen formation. The SmartSkin fractional CO₂ system (Cynosure, Inc., Westford, MA, USA) provides significant improvement for the treatment of facial wrinkles, hyperpigmentation, pore size, and skin laxity associated with photodamage.     

Merkel cells in the vellus hair follicles of human facial skin: a study using confocal laser microscopy

Many cases of Merkel cell carcinoma have recently been reported, and most of them have been localized on the facial skin. In this study, we investigated Merkel cells in the vellus hair follicles of facial region to characterize these cells in human subjects. Skin specimens doubly stained with cytokeratin (CK) 20 and either protein gene product (PGP) 9.5 or vasoreactive intestinal polypeptide (VIP) were examined by confocal laser microscopy. Many of the Merkel cells in the vellus hair follicles of the facial skin were localized in the bulge area. Some of these cells were attached to nerve terminals, although most of them were not associated with them. Our results suggest that there are two types of Merkel cells in the bulge area of the vellus hair follicles of facial skin: cells wholly unassociated with the nerve terminals and cells associated with thin nerve fibers. We postulate that the former cells may be undifferentiated (immature) and the latter differentiated (mature). If this is so, there is a chance that Merkel cell carcinoma originates from the undifferentiated Merkel cells in the bulge of the vellus hair with the formation of tumor masses in the dermis and no involvement of the epidermis. The Merkel cells connected with nerve fibers may secrete endocrine substances via a regulation of autonomic nerves.     

Studies in long-pulsed potassium tritanyl phosphate laser for the treatment of spider naevi and perialar telangiectasia

Utilization of a 1-10 msec vascular laser to treat facial vessels to limit purpura has become available in recent years. Its efficacy and morbidity in the treatment of common vascular lesions require exploration. We have assessed the relative outcomes and morbidity from a single treatment session of two patterns of 'difficult to treat' facial telangiectasia - perialar vessels and spider naevi - with such a system. Two prospective clinical studies with long pulse 532 nm potassium tritanyl phosphate (KTP) laser were performed with subjective and independent objective assessment at 3 days, 1 week and 4 weeks in both studies. Perialar vessels showed good to excellent improvement subjectively at 4 weeks in 53% (8/15), spider naevi in 83% (20/24). Pain of treatment was substantially greater treating perialar telangiectasia than when treating spider naevi (P < 0.01). Morbidity was low in both groups with no long-term complications. Despite the clinical end-point of vessel disappearance at time of treatment and good early improvement in the appearance of perialar vessels, the failure rate was significant at 1 month follow up. It would appear that spider naevi behave more predictably, with vessel disappearance at time of treatment most often forecasting a successful outcome. Although not statistically significant, spider naevi probably respond better than perialar vessels to a single treatment with this laser.     

脉冲染料激光治疗高原地区面部毛细血管扩张症372例疗效观察

目的探讨595nm脉冲染料激光治疗高原地区面部毛细血管扩张症的临床疗效。方法用595nm脉冲染料激光治疗仪治疗面部毛细血管扩张症372例,根据病变程度调整治疗参数,以激光照射瞬间皮损呈浅灰色或轻微紫癜色为适宜能量密度,光斑间可有10%～30%的重叠。结果 372例患者通过1～3次激光治疗后,扩张毛细血管完全消除,有效率为100%。治疗后皮肤无损伤,且有明显的美白淡斑、收缩毛孔及嫩肤的功效。结论用595nm脉冲染料激光治疗高原地区的面部毛细血管扩张症安全性高,且疗效确切。     

Evaluation of effectiveness of erbium:yttrium–aluminum–garnet laser on atrophic facial acne scars with 22‐MHz digital ultrasonography in a Turkish population

Scar formation due to acne is a common problem among the young population and significantly affects their quality of life. The aim of this study was to evaluate the efficacy of erbium:yttrium–aluminum–garnet (Er:YAG) laser resurfacing for acne scars and to objectively demonstrate the altering of collagen density in the dermis by 22‐MHz digital ultrasonography. Twenty‐one patients, aged 19–55 years, with facial acne scars were treated with Er:YAG laser. The results of the laser resurfacing were evaluated for the degree of clinical improvement, alteration of the collagen density by 22‐MHz digital ultrasonography and any adverse effects at 3 months. At 3 months after the treatment, good (in 12 patients) and near total (in four patients) clinical improvement was noted in most of the patients compared to baseline. Overall treatment results were 76% (both near total and good) in 16 patients. By ultrasonographic evaluation, the average density of dermal collagen (total density/number of patients) of 21 patients was 32.714 (right cheek) and 32.142 (left cheek) before laser facial resurfacing. At the third month after treatment, the average density of dermal collagen of 21 patients was 36.380 (right cheek) and 38.809 (left cheek). In conclusion, Er:YAG laser skin resurfacing was found to be a safe and effective treatment modality for treatment of atrophic facial acne scars. As public demand grows for less invasive modalities to approach clinical diagnosis and evaluation, digital ultrasonography seems to provide an easy and confidential method for collagen density evaluation.     

CO2点阵激光联合5-氨基酮戊酸光动力疗法治疗面部光线性角化病的疗效观察

 目的 观察CO₂点阵激光联合5-氨基酮戊酸光动力疗法（ALA-PDT）治疗面部光线性角化病的临床疗效与安全性。方法 采用开放性、非对照性临床研究,对15例面部光线性角化病患者进行CO₂点阵激光联合ALA-PDT治疗,共治疗1~5次,随访1年,观察疗效及安全性。 结果 2例患者经过1次治疗后获得完全缓解,4例2次治疗后完全缓解,9例3～5次治疗后完全缓解,随访12个月均无复发。 3例报告美容效果极好,7例报告美容效果良好,5例报告美容效果一般。治疗过程中,有11例患者轻微疼痛,4例明显疼痛。结论 CO₂点阵激光联合ALA-PDT治疗面部光线性角化病有效,美容效果好。     

Clinical efficacy of the dual-pulsed Q-switched neodymium:yttrium-aluminum-garnet laser: Comparison with conservative mode

Abstract

The quality (Q)-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is one of the first non-ablative lasers to be used for facial resurfacing and photorejuvenation. Recently, the method of low-fluence Q-switched Nd:YAG lasers known as ‘laser toning’ has been used for non-ablative skin rejuvenation and for the treatment of melasma in Asian countries. We report our experience of using a novel Q-switched Nd:YAG laser that was operated as a dual pulse at half fluence and 140-μs intervals compared with conservative mode laser.     

Ultrapulse carbon dioxide laser treatment for bilateral facial nevus comedonicus: A case report

Nevus comedonicus (NC), a rare skin ailment with an aggregation of dilated follicular orifices filled with keratinous material, is difficult to treat. Several drugs have been assessed for the treatment of NC, but with limited success. Surgery requires much experience and the recurrence rate is high. Various types of laser have been tried, with promising outcomes. A 54‐year‐old male patient with bilateral facial NC was admitted on July 8, 2014. A coin‐sized area was first treated successfully with ultrapulse CO₂ laser. The remaining lesions were treated during three subsequent sessions at 2‐week intervals. There were no complications. There was no recurrence after 2 years. This case suggests that ultrapulse CO₂ laser could efficiently alleviate NC. Ultrapulse CO₂ laser treatment should be further studied for its application in the treatment of NC.     

Effects of the 755-nm Alexandrite laser on fine dark facial hair: review of 90 cases

Laser hair removal is a relatively effective method for thick hair. Despite the risk for induction of fine hair growth, application of laser for fine dark hair is sometimes inevitable. We investigate the effects of 755-nm Alexandrite laser on fine dark facial hair and evaluate the induction rates of fine hair growth and case satisfaction. In the present study, the thickening rate of hairs (33.33%) was found to be higher than the previously published rates. However, reduction of hair density can be obtained when the laser sessions are continued.     

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.     

Enhanced efficacy of a topical antioxidants regimen in conjunction with a home-use non-ablative fractional diode laser in photodamaged facial skin

Background: Photodamaged facial skin is characterized by fine lines and wrinkles, mottled pigmentation, and other changes. Objective: To evaluate and compare the efficacy and tolerance of a home-use laser device when used alone or in combination with an antioxidant facial treatment for moderate photodamage. Methods: This was a 49-subject, evaluator-blinded, split-face, randomized, single-center, 24-week, phase-2, study. In phase 1, all subjects were treated on one facial side with test products and a home-use laser device and the other side was treated with laser alone for 12 weeks, followed by a 2-week regression period during which they used only support materials. For phase 2, all subjects were divided into 2 independent treatment groups. For the next 10 weeks, subjects of first group treated the assigned facial side with test products and support materials and the other facial side with only support materials. Subjects in the second group treated their entire face with only support materials. Efficacy and tolerance were assessed by clinical grading, VISIA-CR imaging, and self-assessment questionnaires. Results: The combination of laser and test products improved all photodamage parameters evaluated. Conclusion: The test products enhanced and prolonged clinical benefits obtained with the laser alone.     

Efficacy and safety of mascara dyeing as an adjunct to Alexandrite and Nd:YAG laser applications for removing thin and white-colored facial and axillary hair

Introduction: There is no satisfactory and efficient method for long-term removal of white-colored and thin hair. Methods: We conducted a randomised clinical trial of hirsute patients with excessive white and/or thin hair on the face and/or axilla. In Group I (n: 16), the facial hair on one side of the face was painted with a black eyelash mascara immediately before Nd:YAG laser and the other half was only treated by Nd:YAG. In Group II (n: 20), the axillary hair on one side was painted with the mascara before the Alexandrite laser with the other side being only treated by Alexandrite. Results: The terminal hair counts on the painted facial and axillary sides were significantly lower than those on the control sides throughout the study except for the first month. The decrease in the terminal hair count was significant from the beginning of treatment to the second and sixth months on the painted and control facial sides and to the first and sixth months on the axillary sides. Conclusion: Hair coloring with black eyelash mascara is a simple, efficient and safe adjunct to Alexandrite and Nd:YAG laser applications to enhance their clinical efficacy in eliminating white and thin facial or axillary hair.     

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.     

Histological characterization of age‐related skin changes following the use of picosecond laser: Low vs high energy

Fractional lasers have become widespread in dermatology owing to their efficacy and safety. Comparative analysis of histological features after laser rejuvenation using a 1064‐nm fractionated handpiece picosecond laser with different energy fluence levels (1.1 or 2.1 J/cm²). An open‐label, study of 28 women aged 36 to 60 years with signs of age‐related photodamage and skin changes of the face and neck was conducted using a fractional picosecond 1064 nm laser in low vs high fluence. The clinical assessment at 3 weeks showed more pronounced effect on facial skin rejuvenation with the higher fluence of 2.1 J/cm² compared to 1.1 J/cm². The effect and safety of laser rejuvenation using a picosecond laser has been shown with more pronounced histological effects at higher fluences.