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 micros 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.     

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.     

Lasers for facial rejuvenation: a review

BACKGROUND: Different types of laser are used for resurfacing and collagen remodeling in cutaneous laser surgery. METHODS: A systematic review was performed of the different types of laser currently employed for skin rejuvenation. These systems are either ablative [high-energy pulsed or scanned carbon dioxide (CO2) laser emitting at a wavelength of 10,600 nm, single- or variable-pulse or dual ablative/coagulative mode erbium:yttrium aluminum garnet (Er:YAG) laser emitting at a wavelength of 2940 nm, or systems combining both 10,600 nm and 2940 nm wavelengths] or nonablative [Q-switched neodymium:yttrium aluminum garnet (Nd:YAG) laser emitting at a wavelength of 1064 nm, Nd:YAG laser emitting at a wavelength of 1320 nm, or diode laser emitting at a wavelength of 1450 nm]. Different protocols, patient selection, treatment techniques, and complications are discussed for each system. RESULTS: New-generation CO2 resurfacing lasers have been successful in the treatment of photodamaged skin and scarring, with a postoperative morbidity dependent on the depth of thermal damage. Because of its minimal penetration, the pulsed Er:YAG laser, usually used in the treatment of more superficial rhytides, produces less postoperative morbidity. Novel ablative systems have been developed and a further understanding of laser-tissue interaction has led to the design of nonablative systems for the treatment of rhytides, scarring, and photodamaged skin, the efficacy and profile of which remain to be evaluated in the long term. CONCLUSIONS: There are several effective techniques for scar revision and the treatment of aged skin, but all have their drawbacks due to a lack of precise depth control and unwanted damage to the lower layers of the dermis. The Er:YAG laser is the treatment of choice for fine lines and superficial scars, whereas the CO2 laser is better for deeper rhytides and scars. In the future, a combination of lasers may be used for facial rejuvenation.     

Erbium:YAG cutaneous laser resurfacing

The short-pulsed Er:YAG laser system is an excellent ablative tool for cutaneous resurfacing. This system is most efficacious for patients with milder cutaneous involvement, including mild photoinduced facial rhytides, mildly atrophic scars, and textural changes caused by fibrosis and dermatochalasis. The Er:YAG laser cannot achieve the same dramatic clinical and histologic improvements produced with the CO2 laser but does offer some distinct advantages that make it a valuable addition to the laser surgeon's armamentarium. The Er:YAG laser, because of its higher affinity for water-containing tissues, effects a much finer level of tissue ablation. Although erbium laser resurfacing results in decreased postoperative morbidity with a shorter recovery period, it cannot effect the same degree of improvement in photodamaged skin as can the CO2 laser. Excellent results, however, can be achieved with this laser, up to 50% or more overall clinical improvement, in patients with milder photodamage and scarring (Glogau classes I and II). In darker-skinned patients, the Er:YAG laser is often the preferred treatment modality. Continued research in the field has already led to the development of longer-pulsed Er:YAG lasers, which offer a compromise between the CO2 laser and the short-pulsed Er:YAG lasers in terms of clinical benefits while maintaining the safety profile of the traditional short-pulsed system. In addition, many surgeons now use a combination approach with the CO2 and Er:YAG lasers in an effort to maximize collagen contraction in certain areas and limit postoperative morbidity. As more research is conducted within the field of cutaneous resurfacing, newer systems will be developed in the continuing effort to create the ideal laser system--one which ameliorates the signs of photoaging without risk of major side effects or significant postoperative recovery.     

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.     

A split-face,evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser versus Er:YAG micropeel in light solar lentigines in Asians

Abstract

Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients’ satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.     

Correction of nasolabial folds wrinkle using intraoral non-ablative Er:YAG laser

Background: The accentuated nasolabial folds (NLFs) is the most pronounced sign of aging. Non-ablative erbium:yttrium aluminum garnet laser (ER:YAG), Smooth mode was used for the treatment of mucosal tissue. It was reported that it is effective in facial rejuvenation.

Aim: To assess the safety and the effectiveness of intraoral ER:YAG Smooth mode laser in the treatment of NLFs wrinkle. Materials and methods: A total of 20 patients with different grades of NLFs wrinkle treated with 2940 nm Er:YAG laser intraorally. Six sessions were done every 2 weeks. The efficacy was assessed by two blinded dermatologists. Photographs were taken at the baseline, end of treatment and 6 months after the final session to document visible changes in NLFs wrinkle. The assessment was based on Modified Fitzpatrick Wrinkle Scale (MFWS) and by comparing the photographs. Patient’s self-assessment and patient’s satisfaction were used for assessment of final results and any side effects associated to treatment were observed. Results: There was significant reduction of the NLFs wrinkle. The MFWS was significantly improved 6 months after treatment compared to before treatment (p < 0.001). At the end of the follow-up period, there was improvement in overall appearance of the wrinkles. Patient’s self -assessment and satisfaction demonstrated better cosmetic outcomes. Conclusion: Intraoral Er:YAG laser is safe, painless, and effective treatment option for NLFs wrinkle.     

Treatment of perioral rhytides: a comparison of dermabrasion and superpulsed carbon dioxide laser

OBJECTIVE: To directly compare the cosmetic outcome and adverse effects of dermabrasion and superpulsed carbon dioxide laser for the treatment of perioral rhytides. DESIGN: Subjects were randomly assigned to receive treatment with carbon dioxide laser resurfacing to one side of the perioral area and dermabrasion to the other side in a prospective, comparative clinical study. The duration of follow-up by blinded observers was 4 months. SETTING: University hospital-based dermatologic surgery clinic. PATIENTS: Fifteen healthy fair-skinned volunteers with moderate to severe perioral rhytides and no history of prior cosmetic surgical procedures to the same anatomic area. INTERVENTIONS: One half of the perioral area was treated with the LX-20SP Novapulse carbon dioxide laser (Luxar Corp, Bothell, Wash), and the other half was treated with dermabrasion using either a hand engine-driven diamond fraise or a medium-grade drywall sanding screen (3M Corp, St Paul, Minn). MAIN OUTCOME MEASURES: Improvement in rhytides, patients' subjective reports of postoperative pain, time to reepithelialization, degree of postoperative crusting, and duration of postoperative erythema were observed for both methods. Standardized scoring systems were used to quantify outcome measures. Paired t tests were used for statistical comparisons of the 2 resurfacing methods. RESULTS: The difference in rhytide scores for the 2 methods was not statistically significant (P= .35) at 4 months. Less postoperative crusting and more rapid reepithelialization were noted with the dermabrasion-treated skin. Postoperative erythema was of longer duration on laser-treated skin. Patients reported less pain with dermabrasion treatment. Subtle differences that were difficult to quantify were also noted between the methods. CONCLUSIONS: Both dermabrasion and carbon dioxide laser resurfacing are effective in the treatment of perioral rhytides. Both methods have unique advantages and disadvantages.     

激光和强脉冲光治疗酒渣鼻的治疗进展

酒渣鼻是常见皮肤病,其临床特点包括皮肤潮红、持久性红斑、丘疹脓疱和毛细血管扩张.激光是治疗酒渣鼻毛细血管扩张和鼻赘期的理想选择,最常用的激光包括脉冲染料激光(波长585/595 nm)、长脉宽Nd:YAG激光(波长1064 nm)、CO2激光、铒激光和点阵激光等.强脉冲光、脉冲染料激光用于改善酒渣鼻红斑和毛细血管扩张,安全性高,停工期短.长脉宽Nd:YAG激光仅用于治疗较粗血管和难治性毛细血管扩张.CO2激光、铒激光和点阵激光用于改善酒渣鼻鼻赘.临床上多种激光联合治疗效果更佳.     

Split-face comparison of radiofrequency versus long-pulse Nd-YAG treatment of facial laxity.

BACKGROUND AND OBJECTIVE: To improve photoaging skin with laser treatment, multiple sessions have been considered necessary to achieve results comparable with one radiofrequency (RF) treatment. We compared single-treatment improvements obtained by the long-pulse 1064 nm Nd:YAG laser and RF device. STUDY DESIGN/MATERIALS AND METHODS: In a split-face study, patients with sagging skin were treated once with laser (left side) and once with RF (right side) energy. RESULTS: Improvement judged by six blinded observers was greater for wrinkles and laxity (30% median) on the laser-treated side and essentially the same with both modalities (15% median) for texture, pores, and pigmentation. Improvement was maintained for at least 2-6 months on both facial sides without adverse effects. CONCLUSION: With a single treatment, both the long-pulse 1064 nm Nd:YAG laser and ThermaCool RF device provide a modest degree of improvement in both wrinkles and laxity of facial skin and similar improvement in texture, pores, and pigmentation.     

Maximizing benefits and minimizing risk with CO2 laser resurfacing

Laser resurfacing using the high-energy, pulsed and scanned CO2 laser produces the most dramatic improvement in severe photo-induced facial rhytides and deeply atrophic scars. More recently, the use of short- and long-pulsed erbium lasers in conjunction with CO2 laser resurfacing has been shown to speed healing by removing the upper layer of thermally induced necrotic tissue. The Er:YAG lasers are more superficial ablative tools that inflict less residual thermal damage on the tissue, thus allowing healing to occur without the requisite internal clearance of excessive debris. With continued research and advances in laser surgery, cutaneous resurfacing will be further enhanced with improved outcomes and lessened morbidity.     

Laser peel: facial rejuvenation with a superficial erbium:YAG laser treatment

BACKGROUND : Facial rejuvenation is a popular procedure to temporarily mask the effects of aging. Most patients desiring this treatment are younger and want improvement without any down time. This study was conducted to evaluate the use of Er:YAG laser as a facial rejuvenation tool. METHODS : The full faces of 18 volunteers were treated with an Er:YAG laser using a fluence of either 5 or 10 J/cm 2 . All volunteers applied EMLA ® cream (lidocaine 2.5% and prilocaine 2.5%) two hours before the procedure and were treated with a single pass using a pulse duration of about 300µs. Follow-up visits were made in order to evaluate the degree of discomfort, erythema, swelling and improvement in skin aging. Skin biopsy was performed in one volunteer before and two hours after EMLA ® application, although preceding laser treatment. RESULTS : Most volunteers experienced moderate discomfort during the treatment. There was mild to moderate erythema and mild swelling. The improvement in general skin appearance, actinic bronzing and photo-damage was mild to moderate. The microscopic evaluation of pre-laser treated skin two hours after EMLA ® application was suggestive of increased water content in the dermis. CONCLUSION : The Er:YAG laser is an effective and safe tool for facial rejuvenation. With a superficial treatment, resolution of intense erythema is fairly rapid, averaging two to three days. The improvement, however, is mild compared to full laser skin resurfacing (LSR).     

Combination radiofrequency and diode laser for treatment of facial rhytides and skin laxity.

PURPOSE: As the demand for noninvasive procedures to address cutaneous aging issues has increased, novel nonablative lasers and radiofrequency (RF) devices have recently emerged. The objective of this study was to evaluate the safety and efficacy of a combination RF/diode laser device designed to target both skin laxity and facial rhytides.Materials and methods. Twenty patients (skin phototypes I-III) with mild to moderate rhytides and skin laxity received three treatments at 3-week intervals with a combined radiofrequency and diode laser system (Polaris WR(TM), Syneron Medical Ltd, Israel). Clinical improvement was determined through masked assessments by the treating investigator and two independent assessors after each treatment session, and at 3 and 6 months after the final treatment using a quartile grading scale (1<25%; 2 = 25-50%; 3 = 51-75%; 4>75% improvement). Patient satisfaction surveys were also obtained at end-study. RESULTS: Modest improvement in facial rhytides was observed in the majority of patients as evidenced by investigator and independent assessor evaluations. Patient satisfaction surveys reflected the clinical improvements observed. Side effects were mild and limited to transient erythema and edema. No scarring or pigmentary alteration was seen. CONCLUSIONS: The Polaris WR(TM), which sequentially delivers radiofrequency and diode laser energy, is safe and effective for treatment of mild to moderate facial rhytides and skin laxity. Multiple treatment sessions and laser passes were well tolerated by patients due to the minimization of individual optical and radiofrequency energies used.     

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.     

Controversies in skin resurfacing: the role of erbium

Carbon dioxide laser resurfacing has been a valuable procedure for facial skin rejuvenation since the early 1990s, largely replacing medium and deep chemical peels and dermabrasion. The introduction of the erbium:YAG laser for resurfacing has caused confusion about its role. Because of its ability to resurface very superficially it has been limited by many laser surgeons to treating only superficial rhytides and sun damage. However, it is the equal of CO2 in improving deep rhytides but with quicker healing and fewer side-effects.     

A pilot investigation to subjectively measure treatment effect and side-effect profile of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration laser

BACKGROUND AND OBJECTIVE : Carbon dioxide laser skin resurfacing has become a standard treatment for wrinkles and sun-damaged skin. This ablative treatment, however, is associated with undesirable complications and long recovery times. A growing body of evidence suggests that dermal inflammation and subsequent collagen formation can be stimulated without removal of the epidermis, raising the possibility of effective non-ablative skin remodeling for mild to moderately photodamaged skin. MATERIALS AND METHODS : This preliminary study was performed to evaluate the safety and subject satisfaction of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration, frequency-doubled Nd:YAG laser. Subjects with mild-to-deep lip wrinkles and mild-moderate acne scarring were treated one half of their lip (wrinkles) or cheek (acne scarring), leaving the other side as an untreated control. Subjects were treated at 3-6 week intervals for an average of three treatments. Subjective assessment of improvement was estimated by subject self-evaluation of the percentage improvement over baseline, and a blinded observer attempted to identify the treated side on physical examination. RESULTS : Subjective assessment revealed an average improvement of 51.4% and 53.6% for upper lip wrinkles and facial acne scarring, respectively. Side effects were limited to transient erythema that resolved over 0.25-2 hours following treatment. CONCLUSIONS : These results demonstrate that non-ablative treatment with the 532 nm, 2 ms pulse-duration Nd:YAG laser results in subjective improvement of rhytides and acne scarring, with a high safety profile.     

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.     

Cryogen spray cooling in combination with nonablative laser treatment of facial rhytides.

BACKGROUND: Cryogen spray cooling can be used to provide epidermal protection while still achieving spatially selective photocoagulation in the upper dermis. The objective of this study is to determine the efficacy and safety of cryogen spray cooling in combination with a nonablative Nd:YAG (lambda = 1320 nm) laser treatment of facial rhytides in human volunteers. OBSERVATIONS: Thirty-five adults with bilateral periorbital rhytides were treated with cryogen spray cooling in combination with 3 nonablative laser treatments performed sequentially at intervals of 2 weeks. Small but statistically significant improvements were noted in the mild, moderate, and severe rhytid groups 12 weeks after the final laser treatment. A final assessment performed 24 weeks after the last treatment showed statistically significant improvement only in the severe rhytid group. The procedure was found to be safe; 4 sites (5.6%) developed transient hyperpigmentation. Two sites (2.8%) subsequently developed barely perceptible pinpoint pitted scars. CONCLUSIONS: Cryogen spray cooling is a safe and effective method for protecting the epidermis during nonablative laser treatment of facial rhytides thereby avoiding much of the morbidity associated with other resurfacing procedures. Minor improvements in rhytides can be achieved with the current technology. Optimization of treatment parameters may further improve these results.     

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.     

Combination radiofrequency and diode laser for treatment of facial rhytides and skin laxity

Purpose. As the demand for noninvasive procedures to address cutaneous aging issues has increased, novel nonablative lasers and radiofrequency (RF) devices have recently emerged. The objective of this study was to evaluate the safety and efficacy of a combination RF/diode laser device designed to target both skin laxity and facial rhytides.

Materials and methods. Twenty patients (skin phototypes I–III) with mild to moderate rhytides and skin laxity received three treatments at 3‐week intervals with a combined radiofrequency and diode laser system (Polaris WR^TM, Syneron Medical Ltd, Israel). Clinical improvement was determined through masked assessments by the treating investigator and two independent assessors after each treatment session, and at 3 and 6 months after the final treatment using a quartile grading scale (1<25%; 2?=?25–50%; 3?=?51–75%; 4>75% improvement). Patient satisfaction surveys were also obtained at end‐study.

Results. Modest improvement in facial rhytides was observed in the majority of patients as evidenced by investigator and independent assessor evaluations. Patient satisfaction surveys reflected the clinical improvements observed. Side effects were mild and limited to transient erythema and edema. No scarring or pigmentary alteration was seen.

Conclusions. The Polaris WR^TM, which sequentially delivers radiofrequency and diode laser energy, is safe and effective for treatment of mild to moderate facial rhytides and skin laxity. Multiple treatment sessions and laser passes were well tolerated by patients due to the minimization of individual optical and radiofrequency energies used.