Clinical trial of a laser device called fractional photothermolysis system for acne scars

Ablative laser resurfacing is an effective treatment for acne scars. However, edema and prolonged erythema are common. Additionally, scarring and hyperpigmentation are often induced. A new concept of laser called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation without significant side-effects. We treated 10 patients with acne scars using this laser system (Reliant Fraxel SR Laser). All the patients were successfully treated with minimal adverse effects. The fractional photothermolysis system represents an optional method for the treatment of acne scars.     

The efficacy of conditioned media of adipose-derived stem cells combined with ablative carbon dioxide fractional resurfacing for atrophic acne scars and skin rejuvenation

Objective: To evaluate the effects of conditioned medium of adipose-derived stem cells (ADSC-CM) on efficacy and side effects after fractional carbon dioxide laser resurfacing (FxCR) when treating subjects with facial atrophic acne scars or with skin rejuvenation needs. Materials and methods: Twenty-two subjects were enrolled in the study and divided into two groups. Nine subjects were included in skin rejuvenation group and thirteen subjects were included in acne scar group, and all subjects underwent three sessions of FxCR. ADSC-CM was applied on FxCR site of one randomly selected face side. Evaluations were done at baseline, 1 week after first treatment, and 1 month after each treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), and the erythema and melanin index. Biopsies taken from one subject in skin rejuvenation group were analyzed using hematoxylin and eosin, Masson's Trichrome, and Gomori's aldehyde fuchsin staining. Results: ADSC-CM combined with FxCR increased subject satisfaction, elasticity, skin hydration, and skin elasticity and decreased TEWL, roughness, and the melanin index in both acne scars and skin rejuvenation groups. Histologic analysis showed that ADSC-CM increased dermal collagen density, elastin density, and arranged them in order. Conclusion: ADSC-CM with FxCR is a good combination therapy for treating atrophic acne scars and skin rejuvenation.

Trial registration: JSPH2012-082 – Registered 14 Feb 2012     

A Chinese experience of fractional Ultrapulsed CO2 laser for skin rejuvenation

Abstract

Background and objectives: The ablative fractional CO₂ laser has been successfully used in treating photoaged skin in the Caucasian population. However, its application in Asian skin has not been widely reported. The purpose of this study is to observe the efficacy and safety of the protocol ‘ActiveFX’ for photodamaged facial skin in Chinese patients. Methods: A non-sequential fractional ultrapulsed CO₂ laser with specific settings is used in addition to a new computer pattern generator (CPG). Twenty patients received a single-session, single-pass, ablative fractional treatment on a split face. The patients were evaluated at baseline, and 1 and 3 months (M1, M3) after the treatment using a quartile grading scale. They were also asked to assess their overall satisfaction using a 4-point scale. The improvement of the coarse wrinkles was also quantitatively analyzed with a 3D in vivo imaging system. Results: At M1 and M3, the blinded investigator rated global improvement as 2.8 ± 0.95 and 3.00 ± 0.73, which was consistent with the patients' assessment (2.55 ± 0.83 at M1 and 3.15 ± 0.88 at M3). The roughness analysis (Rz) demonstrated a significant decrease in periorbital wrinkles (p < 0.0001). Minimal and reversible adverse side effects and rapid healing were noted. Conclusions: Non-sequential fractional ultrapulsed CO₂ laser resurfacing (ActiveFX) is considered an excellent treatment modality for photodamaged Chinese facial skin.     

Beneficial effects of spraying low mineral content thermal spring water after fractional photothermolysis in patients with dermal melasma

Introduction  Melasma is a common dermatological skin disease that can now be treated by fractional photothermolysis (fractional resurfacing). Past studies have shown that thermal spring water (TSW) spray can reduce local inflammatory symptoms after dermatological surgery, laser surgery or chemical peelings. The aim of this study was to evaluate the clinical efficacy and safety of spraying TSW post-fractional resurfacing treatment in patients with dermal melasma.
Methods  Twenty patients with bilateral dermal melasma were included in this split-face comparative study. Patients were treated by fractional resurfacing laser and then TSW was sprayed generously unilaterally. For the next 48 h, patients were instructed to spray thermal water at least six times a day on one side. Patient's self-assessment conducted 10 min and 2 days after TSW spraying (stinging, pain, skin dryness, swelling, and redness) and investigator's 48-h post-treatment evaluation (purpura, skin dryness, erythema, swelling, scars, hyper- or hypopigmentation) were recorded for the treated and control sides using visual analogue scales.
Results  Pain, dryness, and redness were significantly lower 10 min after spraying on the TSW-treated side in comparison with the untreated side, as assessed by the patients ( P  <   0.05). Two days after fractional resurfacing, dryness and redness were still improved on the TSW-treated side. The investigator's evaluation revealed that erythema, the only perceivable sign following irradiation, was significantly reduced by TSW spraying ( P  <   0.01).
Conclusion  This split-face comparative study conducted in patients with dermal melasma showed that spraying TSW after fractional laser resurfacing significantly reduced short-term adverse effects associated with the procedure.     

Fractionated CO2 laser skin rejuvenation

Fractional photothermolysis has been reported in the literature to improve both the pigmentary and textural changes associated with photoaging. The objective of the study was to review the literature of non-ablative fractional laser (NAFL) and ablative fractional laser (AFL) resurfacing for the treatment of photoaging. This is a review of the Medline literature evaluating NAFL and AFL for photoaging. Review of the literature supports the use of NAFL and AFL as safe and effective treatments for photoaging. It is likely that the controlled, limited dermal heating of fractional resurfacing initiates a cascade of events in which normalization of the collagenesis/collagenolysis cycle occurs. The advent of fractionated resurfacing for the treatment of photoaging is a significant advance over ablative laser resurfacing treatments, which were complicated by prolonged erythema, delayed onset hypopigmentation, and scarring.     

New vision in fractional radiofrequency technology with switching,vacuum and cooling

Introduction: Since the introduction of fractional technology, various systems were launched to the market. The first generation of fractional RF systems created epidermal ablation with coagulative/necrosis of the dermis with sufficient clinical outcomes, but with some limitations. The aim of this study was to evaluate the efficacy and safety of SVC technology, based on the principle of separate biological responses. Material and methods: Fifty-two patients were treated for 3–6 sessions using fractional RF handpiece and eight patients received combination treatments with non-invasive RF handpiece. Results: All volunteers showed notable to significant improvement in the photoageing symptoms, without any significant complications or adverse events. Discussion: Due to its wide spectrum of parameters, the SVC technology can promote different biological responses. Owing to the “Switching” technology, the control of energy depth penetration enables delivery of the necessary thermal dose to the targeted skin layer. In addition, this novel technology includes the “Vacuum” and “Cooling” mechanisms, each contributing to the safety of the treatment. The Smart Heat function reduces the necessary energy levels and thereby reduces the pain level and risks for side effects.     

Nonablative skin rejuvenation

Laser resurfacing of photodamaged or scarred skin has traditionally involved the use of ablative lasers with their associated limitations and side effects. Nonablative skin rejuvenation is a relatively new concept in facial rejuvenation, which aims to induce dermal remodeling without visible epidermal disruption. A number of laser devices and light sources, emitting at various wavelengths, have been shown to effectively enhance the appearance of facial skin through nonablative mechanisms. Among the conditions that can be treated with this novel modality are erythema, telangiectasia, pigmentation, lentigines, and textural imperfections ranging from fine and moderate rhytides to other surface irregularities such as acne scarring. A major attraction of nonablative laser therapy is the very limited downtime after each treatment, making it an ideal method for patients seeking a minimally invasive procedure with an excellent safety profile.     

The use of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin: a pilot study

Background: Various modalities have been used to treat acne scars, but limited efficacy and considerable side effects have restricted their proper use. Recently, a new-generation fractional photothermolysis modality has been introduced that has deeper penetrating ability; however, a 1540 nm fractional photothermolysis study has not yet been performed.
Objectives: To evaluate the efficacy and safety of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin.
Methods: Sixteen volunteers (Fitzpatrick skin types III–IV) with mild to moderate acne scars were enrolled. Acne scar lesions were treated with 1540-nm fractional photothermolysis (Starlux^™ 1540). Three treatment sessions were performed for each patient 4 weeks apart. Outcome assessments included the following four methods: (1) clinical evaluation of the photographs that were taken before and after the treatment; (2) comparison of the quality of life (QOL) of the patients before and after the treatment; (3) patients' satisfaction with the treatment; and (4) comparison of the quantity of collagen and elastic fibers in the skin biopsies before and 12 weeks after the last treatment.
Results: A mild to moderate clinical improvement was observed in most of the patients. Moreover, the QOL of all the patients improved, and all of them were satisfied with the results of the treatment. Significant collagen and elastic-fiber increases were also observed after the treatment, and side effects were limited to transient erythema and edema, which occurred in 50% of the patients. No severe side effect was observed.
Conclusions: 1540 nm fractional photothermolysis is an effective and safe method for improving acne scar, even in Asian skin.     

Evaluation of the efficacy and safety of fractional bipolar radiofrequency with high-energy strategy for treatment of acne scars in Chinese

Background: Fractional technology overcomes several problems of ablative lasers such as a high incidence rate of post- inflammatory hyperpigmentation (PIH). A new technology fractional radiofrequency, which induces deep dermal heating and leaves the epidermal less affected results in less adverse effect in Chinese. Objective: To evaluate the efficacy, safety and tolerance of fractional bipolar radiofrequency (RF) in the treatment of acne scars in Asian people with the strategy of high energy. Methods: Twenty-six healthy Asian patients with acne scars received four monthly high energy (85–95mj/pin) treatments with a fractional bipolar RF device. Improvement and tolerance were evaluated at each treatment and a 4-week and 12-week follow-up visit. Results: Twenty-three patients completed the study. Acne score showed a significantly decrease at 4-week and 12-week follow-up visits. Patients’ evaluation of global improvement and satisfaction increased at the 12-week visit compared with baseline. Side effects were limited to transient pain, erythema, dryness and low risk of PIH. Conclusion: Treatment with high energy of fractional bipolar RF is safe and effective for acne scars in Asian people. Common side effects such as PIH, eschars are less than fractional lasers.     

Fractional photothermolysis treatment for resistant melasma in Chinese females

Background: Melasma is a common disorder of pigmentation which is common in women of Asian and Latina descent. Melasma lesions are resistant to numerous laser therapies, but have responded well in clinical studies to fractional photothermolysis. Objective: To determine whether Chinese women with resistant melasma will respond to fractional photothermolysis. Methods: Six female patients &lpar;Fitzpatrick skin types III-IV&rpar; were treated with fractional photothermolysis at approximately 4 week intervals. Three to four treatments were performed for each patient. Before and after photos were taken of each patient in order to identify the degree of improvement of the pigmented lesions treated. Results: All patients who participated in the study experienced at least 20% improvement in the appearance of their melasma lesions. Three patients obtained 50% improvement, two obtained 30% improvement, and one obtained 20% improvement. Conclusion: Fractional photothermolysis is a useful treatment modality for Chinese women who have resistant melasma.     

Syringoma of the face treated with fractional photothermolysis

Abstract

We experienced that two Japanese women diagnosed with syringoma, confirmed by a punch biopsy, were successfully treated with fractional resurfacing. Both clinical cases have had positive results after only a few treatments, with high patient satisfaction, not only for the improvement of syringoma, but also for the improvement of aging skin, and with no side effects. From that aspect, laser treatment with fractional photothermolysis may be considered to be one of the effective treatment methods for syringoma. Although fractional photothermolysis was originally developed for an aesthetic purpose, it also can be utilized for intractable skin disease, as demonstrated by taking the concept of fractional photothermolysis and the results from this study with skin biopsy.     

A novel fractional micro-plasma radio-frequency technology for the treatment of facial scars and rhytids: A pilot study

Abstract

Introduction: Fractional ablative and non-ablative lasers have gained popularity in the treatment of acne scars and rhytids due to their efficacy and improved tolerability. Plasma and radio frequency (RF) have also emerged as methods for ablative or non-ablative energy delivery. We report preliminary experience with a novel fractional micro-plasma RF device for the treatment of facial acne scars and rhytids. Methods: Sixteen patients with facial acne scars or rhytids were treated at 4-week intervals. Treatment parameters were titrated to an immediate end point of moderate erythema. The clinical end point for cessation of treatment was the attainment of satisfactory clinical results. Results were monitored photographically up to 3 months after treatment. Results: Acne scars showed marked improvement after two to four treatments. Facial rhytids demonstrated reduced depth after two treatments and marked improvement after four treatments. Treatment was well tolerated by all participants, with transient erythema and short downtime. These results provide initial evidence for the safety and effectiveness of fractional micro-plasma RF as a low-downtime and well-tolerated modality for the treatment of acne scars and facial rhytids.     

CO_2点阵激光Deep与Superficial模式联合治疗萎缩性痤疮瘢痕的临床分析

目的:评价CO2点阵激光Deep与Superficial模式联合治疗萎缩性痤疮瘢痕的临床疗效和安全性。方法:对纳入的20例萎缩性痤疮瘢痕患者进行病例对照研究,每例患者治疗2个疗程,治疗后3个月进行疗效和安全性评价,对治疗前后萎缩性痤疮瘢痕严重程度评分,评估临床疗效和不良反应,同时统计患者主观评价。结果:所有患者瘢痕严重程度评分由治疗前(64.3±19.8)分下降至(39.8±14.3)分,改善百分比达(37.6±9.6)%,其中17例患者认为皮损明显或显著改善,无严重不良反应。结论:CO2点阵激光Deep与Superficial模式联合治疗萎缩性痤疮瘢痕,是一种安全有效的新型治疗方法。     

Treatment of acne scars by fractional bipolar radiofrequency energy

Abstract

Background/Objective: A variety of modalities are available for the treatment of acne scars. This prospective, IRB-approved study evaluates the efficacy and tolerance of fractional bipolar RF energy in the treatment of facial acne scars. Methods: Healthy subjects (n =?15, 13 females, aged 35.7?±?5.6 years [mean ± SD], skin types I–V) with mild to moderate acne scars received three monthly treatments with a fractional bipolar RF device. Improvement and tolerance were evaluated at each visit, including a 1-month and 3-month follow-up visit. Results: Ten subjects completed the study. Physician-assessed acne scar severity was significantly reduced at 1 month and 3 months. Adverse effects were limited to transient erythema. Dryness, bruising and crusting erosion were limited. Subject-assessed stinging/burning, stinging (alone), tingling, itching and burning were also limited and consistent with each treatment. Subject-assessed fine lines and wrinkles, brightness, tightness, acne scar texture, pigmentation were all improved significantly. Satisfaction was high in 67–92% of subjects. Conclusion: Fractional bipolar RF energy is a safe and effective modality for the treatment of acne scars.     

The efficacy of fractional ablative carbon dioxide laser combined with other therapies in acne scars

Fractional ablative carbon dioxide laser resurfacing is a frontline treatment for acne scars. It creates multiple microscopic treatment zones to accelerate the collagen formation and the healing process of reepithelialization, according the principle of fractional photothermolysis. At present, the fractional CO₂ laser with a wavelength of 10,600 nm is commonly used in the field of cosmetology and clinical therapies for various skin diseases, and it can effectively improve skin regeneration and scar formation. To obtain satisfactory results for patients with scars, repetitive fractional laser therapy is always required; however, this treatment could easily lead to complications such as erythema, edema, infection, and post‐inflammatory hyperpigmentation. In addition, different types of acne scars may have different responses to laser, further limiting its widespread use. In recent studies both home and abroad, a new pattern of fractional laser combined with other therapies to improve acne scar has been recommended to guarantee the safety and effective of treatment. This article reviews the recent pertinent literatures and summarized the progression of ablative fractional CO₂ laser combined with other therapies on acne scar.     

Combined fractional resurfacing (10600 nm/1540 nm): Tridimensional imaging evaluation of a new device for skin rejuvenation

In this study were described the results, by tridimensional imaging evaluation, of the new “Combined Fractional Resurfacing” technique with the first fractional laser that overtakes the limits of traditional ablative, nonablative fractional resurfacing by combining CO₂ ablative and GaAs nonablative lasers. These two wavelengths can work separately or in a mixed modality to give the best treatment choice to all the patients. In this study, it is demonstrated that the simultaneous combination of the CO₂ wavelength (10600 nm) and GaAs wavelength (1540 nm) reduced the downtime, reduced pain during the treatment, and produced better results on fine wrinkles reduction and almost the same results on pigmentation as seen with 3D analysis by Antera (Miravex).     

Fractional treatment of aging skin with Tixel,a clinical and histological evaluation

Objective: This study presents clinical results of Tixel, a new fractional skin resurfacing system based on thermo-mechanical ablation technology. Tixel employs a hot (400°C) metallic tip consisting of 81 pyramids. Treatment is performed by rapidly advancing the tip to the skin for a preset tip–skin contact duration. Thermal energy transfer to the skin creates micro-craters by evaporation. Methods: Treatment results with tip types, D and S, with high and low thermal conductivity, were evaluated. Twenty-six subjects received three facial treatments, with 4–5-week intervals between treatments, without analgesia or cooling. In addition, histopathologies of Tixel and CO₂ laser were performed. Results: Crater properties are related to contact duration and to thermal conductivity. The D tip created char-free ablative craters 100–320 μm wide with a thermal zone 100–170 μm deep. The S tip created non-ablative coagulation preserving the epidermis. Skin complexion improvement was achieved in all subjects; average treatment pain of 3.1/10, downtime of 0–1 days, and erythema clearance of 3.5 days. Subject's satisfaction was 75% and wrinkle attenuation was achieved in 75% of the cases. There was no incidence of bleeding, scarring, or post-inflammatory hyperpigmentation. Conclusions: Tixel may be used safely for ablative and non-ablative resurfacing with low pain, low downtime, and quick healing.     

A retrospective study on the clinical efficacy of the intense pulsed light source for photodamage and skin rejuvenation

Objective: The objective of this retrospective review is to investigate the long-term effect of skin rejuvenation by the intense pulsed light (IPL) source for the treatment of photoaging. Methods: From 5300 clinical cases that our department has treated with the IPL, the first 2534 were chosen for this study. Each patient received a minimum of 3 IPL treatments during this time—many were yearly treatments. Clinical photographs were taken on a yearly basis for up to 12 years and sent to a blinded independent panel to study the effects of continuous IPL treatments. Results: Results showed that the effective rate for the IPL was between 88.24% and 96.45%. Conclusions: IPL therapy is an effective treatment for photoaging and can truly have an effect on reversing the signs of photodamage on skin.