Treatment of Striae Distensae with Nonablative Fractional Laser versus Ablative CO2 Fractional Laser: A Randomized Controlled Trial

Background

Striae distensae are atrophic dermal scars with overlying epidermal atrophy causing significant cosmetic concern. Although a variety of laser and light sources have been used for the treatment of striae distensae, to date no definite ''gold standard'' treatment modality has been determined.

Objective

To assess and compare the efficacy and safety of nonablative fractional photothermolysis and ablative CO₂ fractional laser resurfacing in the treatment of striae distensae.

Methods

Twenty-four ethnic South Korean patients with varying degrees of atrophic striae alba in the abdomen were enrolled in a randomized blind split study. The patients were treated with 1,550 nm fractional Er:Glass laser and ablative fractional CO₂ laser resurfacing. Each half of the abdominal lesion was randomly selected and treated three times at intervals of 4-weeks using the same parameters. Digital photography was conducted and skin elasticity and the width of the widest striae in each subject were measured at the baseline and 4 weeks after the final treatment. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs by two blinded physicians and participant satisfaction rates were evaluated. Skin biopsies were taken from three participants. All adverse effects were reported during the study.

Results

Although they do not statistically differ, both treatments with nonablative fractional laser and ablative CO₂ fractional laser showed a significant clinical and histopathologic improvement of striae distensae over pretreatment sites.

Conclusion

These results support the use of nonablative fractional laser and ablative CO₂ fractional laser as effective and safe treatment modalities for striae distensae of Asian skin. However, neither treatment showed any greater clinical improvement than the other treatment.     

A new multi-modal fractional ablative CO2 laser for wrinkle reduction and skin resurfacing

Abstract

Background: The concept of fractional delivery modality of the energy with both ablative and non-ablative devices is now well known and accepted as an effective method to attain significant aesthetic improvements on facial aging skin. A new, multi-modal, fractional, ablative CO₂ laser that can create, using same scanner/handpiece, deep columns in addition to superficial ablation has been recently proposed and therefore investigated. Method: Twenty-four patients were enrolled in this evaluation. Each of them received one multi-modal, fractional ablative treatment. Patients were clinically and photographically evaluated at baseline and 6 months after the procedure. The degree of photoaging and the efficacy of treatment were evaluated using a VAS five-point scale of some skin features. A 3D images comparison was furthermore performed to objectify the improvements. Results: For all of the analysed skin features of photodamage a significant, statistical improvement was obtained. The data collected with the 3D system demonstrated an average improvement of 42% of the wrinkles and an average improvement of the melanin variation of 40.1%. Conclusions: The multi-modal approach with a single handpiece allows obtaining good outcomes with a very low incidence of adverse effects and a short downtime.     

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.     

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).     

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.     

Complications and posttreatment care following invasive laser skin resurfacing: A review

Objective: Laser skin resurfacing (LSR) has been used for facial rejuvenation for the last 20 years. Posttreatment care after LSR is essential to decrease the risk of complications. Currently, no unified standards or criteria exist for invasive LSR posttreatment care. We aimed to identify the optimal wound care timing and choice of specific local, systemic, and general medical measures required to decrease complications. Methods: We performed a systematic search of the PubMed/MEDLINE electronic databases and included only articles written and published in the English language, with no restrictions on the publication time (year). Results: The search yielded 316 potentially relevant articles, 133 of which met our review criteria. Most of the studies on this topic have focused on wound care during the early stage, typically the first 2 weeks. Closed dressings may offer a more ideal, moist wound environment. The use of medications must be judicious. The ongoing emergence of new methods and products warrants evaluation in future large clinical trials. Summary: Familiarity with the complications following invasive LSR and the provision of optimal, effective, and timely posttreatment care may substantially decrease the risks associated with the treatment modality.     

Safety and efficacy of human platelet extract in skin recovery after fractional CO2 laser resurfacing of the face: A randomized,controlled, evaluator-blinded pilot study

Background

Fractional carbon dioxide (CO₂) laser resurfacing is used successfully for facial rejuvenation. Post procedure skincare is a variable that influences downtime caused by pain/tenderness, erythema, crusting, and bruising.

Aims

The primary objective of this pilot study was to demonstrate the benefits of human platelet extract (HPE) (plated)™ CALM Serum, a new topical cosmetic product, following fractionated CO₂ ablative laser resurfacing treatment to the entire face versus standard of care.

Methods

In a single-center, randomized, evaluator-blinded pilot study, a total of 18 subjects were randomized into two groups, CO₂ facial resurfacing followed by post-procedural standard of care (Stratacel silicone gel) or CO₂ facial resurfacing with the addition of HPE renewosomes in the CALM Serum.

Results

CALM Serum demonstrated statistically significant less crusting at Day 10 compared to the control group (p = 0.0193) with less downtime in the first 14 days (p = 0.03). Subjects treated with CALM Serum had statistically significant brighter appearing skin at 14 days (p = 0.007) and more youthful looking skin on Days 14 and 30 (p = 0.003 and 0.04, respectively).

Conclusions

This study demonstrates that Renewosome™ technology provides statistically significant post-laser clinical recovery over silicone gel for reducing crusting, and downtime. Subjects reported less diary days of symptoms of pain/tenderness, redness, crusting/flaking, bruising, and itching in the first 14 days compared to the control group. CALM also demonstrated statistically significant improvements in brighter and more youthful appearing skin. CALM is safe and well tolerated.     

Fractional CO2 laser resurfacing of photoaged facial and non-facial skin: Histologic and clinical results and side effects

Abstract

Background: CO₂ fractional ablation offers the potential for facial and non-facial skin resurfacing with minimal downtime and rapid recovery. Objectives: The purpose of this study was (i) to document the average depths and density of adnexal structures in non-lasered facial and non-facial body skin; (ii) to determine injury in ex vivo human thigh skin with varying fractional laser modes; and (iii) to evaluate the clinical safety and efficacy of treatments. Methods: Histologies were obtained from non-lasered facial and non-facial skin from 121 patients and from 14 samples of excised lasered thigh skin. Seventy-one patients were evaluated after varying energy (mJ) and density settings by superficial ablation, deeper penetration, and combined treatment. Results: Skin thickness and adnexal density in non-lasered skin exhibited variable ranges: epidermis (47–105 μm); papillary dermis (61–105 μm); reticular dermis (983–1986 μm); hair follicles (2–14/ HPF); sebaceous glands (2–23/HPF); sweat glands (2–7/HPF). Histological studies of samples from human thigh skin demonstrated that increased fluencies in the superficial, deep and combined mode resulted in predictable deeper levels of ablations and thermal injury. An increase in density settings results in total ablation of the epidermis. Clinical improvement of rhytids and pigmentations in facial and non-facial skin was proportional to increasing energy and density settings. Patient assessments and clinical gradings by the Wilcoxon's test of outcomes correlated with more aggressive settings. Conclusions: Prior knowledge of normal skin depths and adnexal densities, as well as ex vivo skin laser-injury profiles at varying fluencies and densities, improve the safety and efficiency of fractional CO₂ for photorejuvenation of facial and non-facial skin.     

Comparison of the efficacy of carboxytherapy versus fractional CO2 laser therapy for the treatment of periorbital dark circles: A randomized clinical trial

Background

Periorbital dark circles (PDC) is one of the most common cosmetic issues in today's society. Only moderate degree of improvement has been achieved by various available treatment options. The present study aimed to compare the clinical efficacy of carboxytherapy and fractional CO₂ laser therapy in the management of PDC.

Methods

In this split face study, 30 patients with bilateral PDC aged between 23 and 52 years were recruited who underwent carboxytherapy (n = 30) on PDC of one side of the face and fractional CO₂ laser therapy (n = 30) on the PDC of other side. The entire treatment comprised of four sessions of each therapy with an interval of 2 weeks each time. The assessment was based on both subjective methods (patients' satisfaction and physician's judgment) and objective method (based on digital standard photographs). The degree of improvement from the patient's point of view (patient satisfaction) and physician's point of view (physician satisfaction) was assessed in different therapy sessions in comparison with the improvement after first session.

Results

The study included 30 patients with mean age of 38.22 ± 8.3 years. The mean disease duration was 45 ± 12.3 months. After the second therapy session, patients' satisfaction was remarkably better in the fractional CO₂ laser therapy group than the carboxytherapy group, over the time. According to the physician satisfaction, the improvement rate was higher after the second and sixth weeks in the fractional CO₂ laser therapy group than the carboxytherapy group; whereas in other sessions, there were no statistically significant differences. There were no significant side effects observed in either group post-treatment each time.

Conclusion

Fractional CO₂ laser therapy is a better option to treat PDC than carboxytherapy. Also, mild side effects (including erythema, pain, and discomfort) were reported in both groups; with no significant difference between the groups.     

A case of successfully treated recalcitrant EGFR inhibitor‐induced acneiform eruption following non‐ablative fractional laser

Epidermal growth factor receptor (EGFR) inhibitor, a targeted therapy in the field of oncology, is a new drugs suggested for the cause of acneiform eruptions. The unresponsiveness to conventional acne therapy is a pivotal reason of seeking alternatives to treat drug‐induced acneiform eruptions. A 30‐year‐old female treated with cetuximab, EGFR inhibitor presented with numerous sized erythematous papules and pustules on her face. All responses of oral medications and topical application were poor. She was treated with two passes of non‐ablative 1550 nm fractional erbium glass laser with topical clindamycin. After three laser sessions, the skin lesions improved dramatically without any side effects. There is currently no single effective treatment for acneiform eruption. This report shed light on the possibility that non‐ablative fractional laser can be an alternative for recalcitrant drug‐induced acneiform eruptions.     

Treatment of striae distensae using fractional ablative CO2 laser in skin types II-IV: a retrospective case series study

Striae distensae (SD) are atrophic dermal scars often found on abdomen, breasts, thighs, and hips of pregnant women. The strias’ self-healing without any intervention is a poor possibility. Till now, several lasers and light sources have been used for treatment of SD. However, there are no integrated therapeutic approaches determined for treatment of SD yet. So, in this study, the therapeutic effect of fractional ablative CO₂ laser in women with pregnancy was assessed. Twenty-four ethic Iranian women aged between 20 and 42 years with various severity of pregnancy SD enrolled in retrospective case series study. Participants with skin types II-IV were treated in four sessions with a one-month interval by fractional ablative CO₂ laser. The severity of striae was determined by Daveys scoring. Clinical improvement was assessed by comparing pretreatment and posttreatment clinical photographs based on global improvement scoring. The evaluation of clinical results showed that fractional ablative CO₂ laser was an effective treatment. Twenty of 24 (83.3%) patients showed improvement. Clinical improvement was affected by striae severity (P = 0.03). Also, there were no statistical differences between clinical improvements with skin types, striae scar severity, number of pregnancy, and striae location.     

Ablative fractional CO2 resurfacing for photoaging of the hands: pilot study of 10 patients

Extrinsic aging of the hands involves alterations in pigmentation, wrinkling, and texture as a result of chronic ultraviolet and environmental exposures. Inherent tissue properties of the skin of the dorsal hand have made it challenging to safely and effectively improve all three parameters of photoaging with a single device. Recent successes with non-ablative fractional lasers on the hands, as well as success of ablative fractional lasers on the neck and chest, raise the question of potential efficacy of ablative lasers for photorejuvenation of the hands. This was a prospective pilot study of ablative fractional CO(2) laser in 10 participants, each receiving three treatments to one hand at 4-6-week intervals. Subjective assessments by investigator and participants were performed 1 month after each treatment. At 1-month follow-up after final treatment, investigators rated mean improvement of 26-50% for wrinkles, 51-75% for pigment, and 26-50% for texture. Participants rated mean improvement after final treatment as 26-50% for wrinkles, 51-75% for pigment, and 51-75% for texture. Other than significant edema noted in one participant after the first treatment, side effects were limited to transient erythema and edema, with no long-term scarring or pigmentary alteration. In this pilot study, ablative fractional resurfacing was safe and effective for the treatment of all markers of extrinsic aging of the hands. A high degree of improvement was achieved in two to three treatments with no long-term sequelae.     

CO2 laser treatment for plantar warts in children: A case series

Several types of human papillomaviruses induce warts. Warts are one of the most common infections in childhood with a reported prevalence of up to 20%. Warts are divided clinically into genital and nongenital forms. Plantar warts are common nongenital warts. In this series, five pediatric cases treated with CO₂ laser for their plantar warts are presented. One patient was a known case of Hodgkin's lymphoma. Three of our patients had history of unsuccessful treatments with other modalities, while the other had received no previous treatment. CO₂ laser with continuous mode (focused and defocused) was used. In our cases, only one session was enough for clearance of the warts. All the patients were visited 1 week and 3 months after treatment to assess the efficacy and any possible recurrences. Follow‐up showed that all the patients remained in remission up to 3 months posttreatment with no adverse events.