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

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

Comparative Treatment of Giant Congenital Melanocytic Nevi with Curettage or Er:YAG Laser Ablation Alone versus with Cultured Epithelial Autografts

BACKGROUND: Treatment options for congenital melanocytic nevi (CMN) include complete surgical excision, dermabrasion, curettage, and laser therapy. Fresh cultured epithelial autograft (CEA) after curettage or erbium:yttrium-aluminum-garnet (Er:YAG) ablation presents a novel option in the management of large-sized or giant CMN. OBJECTIVE: The purpose of this study was to evaluate the outcome of CEA after curettage or Er:YAG ablation of CMN and to compare the safety, efficacy, and side-effect profile of CEA with the non-CEA group. METHODS: Ten patients with CMN were treated with curettage (one patient), Er:YAG ablation (four patients), or both (five patients) followed by CEA, and eight patients were treated with curettage (two patients), Er:YAG ablation (one patient), or both (five patients) without CEA. All 18 patients were evaluated at week 16 after the operation with respect to pigmentation, erythema, hypertrophic scarring, textural change, granulation tissue formation, infection, and healing time. Global Assessment Scale scores were graded before and 16 weeks after the operation by physicians and patients. RESULTS: Reduced pigmentation in the treated areas was seen in both groups, but the time to complete healing was significantly shorter in the CEA than in the non-CEA group (p < .05). There was less hypertrophic scar formation and granulation tissue formation and fewer other side effects in the CEA group. CONCLUSION: In view of the favorable outcome of CEA combined with curettage or Er:YAG laser ablation in the treatment of giant CMN, CEA is a safe and effective novel treatment adjunct that accelerates healing, with fewer side effects.     

Er:YAG Laser Treatment of Verrucous Epidermal Nevi

BACKGROUND: The term verrucous epidermal nevi refers to benign hyperplasia of the epidermis. Numerous treatment modalities have been tried, but no ideal treatment is yet available. We would like to present our experience with Er:YAG laser ablation in the treatment of verrucous epidermal nevi. OBJECTIVE: The purpose of this study is to assess the long-term results of Er:YAG laser treatment of verrucous epidermal nevi. METHODS: Twenty patients with verrucous epidermal nevi were treated with Er:YAG laser. Twelve patients were treated with the variable-pulsed Er:YAG laser, a 5-mm handpiece at the setting of 7.0 to 7.5 J/cm2, at a 500-micros pulse duration. The dual-mode Er:YAG laser, with a 2-mm handpiece at the setting of 6.3 J/cm2, at a 350-micros pulse duration (25 microns ablation), was used in eight patients. The laser was fired at 5 Hz until all epidermal nevi were removed. The results of treatment were evaluated for the changes of skin lesions, texture, and color by physicians over a 24-month period. RESULTS: After a single laser treatment, successful elimination of the verrucous epidermal nevi was observed in 15 patients. Five patients (25%) showed a relapse within 1 year after the treatment. Postoperative healing time was 7 to 10 days. Erythema occurred in all patients after the laser treatment and subsided in 2 months. Postinflammatory hyperpigmentation occurred in two patients (10%). One patient (5%) experienced transient hypopigmentation. Mild to moderate postoperative acne flare-up occurred in one patient (5%) with facial lesions. No other adverse effects, including scarring, were observed. CONCLUSION: The Er:YAG laser ablation is an effective, safe, and nonscarring method for the treatment of verrucous epidermal nevi.     

Laser resurfacing with a long pulse erbium:YAG laser compared to the 950 ms pulsed CO(2) laser

BACKGROUND AND OBJECTIVE: Laser resurfacing with the 950 micros pulsed CO(2) laser is an effective treatment for photodamage and acne scarring; however, the potential for prolonged erythema and delayed re-epithelialization dissuade many patients from the procedure. With the use of erbium lasers alone, there is a decrease in the incidence and severity of these adverse sequelae; however, it is difficult to achieve the same degree of improvement as with the CO(2) laser because of the more superficial depth of resurfacing. Thus, new erbium lasers have been developed with longer pulse durations to deliver increased thermal effects to tissue. It is hypothesized that with the use of these lasers, diminished erythema and faster wound healing will be observed as well as enhanced clinical outcomes. STUDY DESIGN/MATERIALS AND METHODS: Sixteen patients were randomized to receive laser resurfacing on one-half of the face with the 950 micros pulsed CO(2) laser (UPCO(2)) followed by short pulse erbium:YAG ablation, and to the other half with a variable pulsed erbium laser (VP Er:YAG) followed by traditional short pulse erbium laser. Patients were evaluated clinically before resurfacing and at 1, 2, 4, 8, and 12 weeks post-operatively. Histologic samples taken at various time periods before and after resurfacing were also evaluated. RESULTS: Overall clinical improvement was equal for both UPCO(2) and VP Er:YAG treated sides with an average improvement in photoaging scores of 57%. Decreased erythema, less edema, and faster healing were observed on the VP Er:YAG treated side. CONCLUSION: The VP Er:YAG laser can achieve a similar degree of improvement as seen with short pulse CO(2) laser resurfacing with decreased thermal tissue effects and decreased risk for adverse sequelae.     

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

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

Xanthelasma palpebrarum: treatment with the erbium:YAG laser

BACKGROUND AND OBJECTIVE: Xanthelasma palpebrarum presents a therapeutic and aesthetic challenge because of its high visibility and frequent rate of recurrence with a wide variety of treatments. Many patients are disappointed by an initial unsuccessful treatment and fail to return for further therapy until the skin problem has become quite conspicuous. A simple treatment with few side effects and good acceptance remains an important goal. STUDY DESIGN/MATERIALS AND METHODS: Fifteen patients with a total of 33 xanthelasma lesions, were treated by an erbium:YAG laser. The follow-up period of observation was between seven and twelve months. RESULTS: All lesions were removed without hyperpigmentation or scarring. CONCLUSIONS: The erbium:YAG laser represents an effective means for treating xanthelasmas with few side effects.     

Treatment of Multiple Eruptive Hair Cysts with Erbium:YAG Laser

BACKGROUND: Eruptive vellus hair cysts (EVHC) frequently resist a variety of treatment modalities. While pulsed carbon dioxide (CO2) laser has been used effectively for facial EVHC, this laser presents significant risks for hypertrophic scarring when used on truncal sites. Due to absorption of 2940 nm energy by both tissue water and protein, the erbium:yttrium-aluminum-garnet (Er:YAG) laser ablates more cleanly and creates less residual thermal injury in the wound bed. This laser might prove efficacious and safe in treating nonfacial EVHC. OBJECTIVE: To assess treatment efficacy and wound healing after Er:YAG laser ablation of EVHC. METHODS: Two patients with 32 truncal EVHC were treated with pulsed Er:YAG laser using a drilling technique followed by second intention healing. RESULTS: Laser treatment sites healed without permanent dyspigmentation or hypertrophic scarring. No lesion recurrence was observed. CONCLUSION: Er:YAG laser ablation is an effective method for treating EVHC at anatomic sites prone to hypertrophic scar formation.     

Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing

BACKGROUND: Several erbium:YAG lasers are currently available for cutaneous laser resurfacing. Although different laser systems are purported to produce equivalent laser energies to produce similar laser-tissue interactions, no comparative clinical or histologic studies have been performed to objectively demonstrate their relative efficacies. OBJECTIVE: The purpose of the present study was to examine the in vivo clinical and histopathologic effects of six different erbium:YAG resurfacing lasers. METHODS: A blinded, prospective study using six different erbium lasers (Candela, Continuum Biomedical, HGM, MDLT, SEO, Sharplan/ESC) was performed. The facial halves of 12 patients were randomly resurfaced with one of the six laser systems by using an identical laser technique at 5.0 J/cm2. Intraoperative skin biopsies were obtained after each of three laser passes in two patients for blinded histologic determination of tissue ablation level and presence of residual thermal damage. Clinical assessments of reepithelialization rates, severity and duration of erythema, side effects, and degree of clinical improvement were made at 0.5, 1, 2, 4, 12, 26, and 52 weeks postoperatively. RESULTS: Irrespective of the erbium laser system used, complete reepithelialization typically occurred at 0.5 weeks and resolution of erythema was noted within 1-2 weeks postoperatively. A mean clinical improvement of 50% was observed, with photodamaged skin showing greater improvement than scarred skin. The most common postoperative side effect was hyperpigmentation, with all affected patients having either darker skin tones or preceding dermal inflammation. Three laser passes were needed to effect total epidermal ablation when using any one of the erbium:YAG systems. CONCLUSIONS: Equivalent clinical and histologic results were seen after each of the six erbium:YAG lasers studied. Erbium:YAG laser resurfacing can be used to significantly improve mild cutaneous photodamage and atrophic scars.     

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

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

Novel Use of Erbium:YAG (2,940-nm) Laser for Fractional Ablative Photothermolysis in the Treatment of Photodamaged Facial Skin: A Pilot Study

BACKGROUND The use of CO₂ or conventional erbium laser ablation or more recent nonablative laser photothermolysis for skin rejuvenation is associated with significant disadvantages.
OBJECTIVE The objective was to assess the efficacy of the erbium:YAG laser (2,940 nm) using the "ablative" fractional resurfacing mode to improve photodamaged skin.
METHODS A total of 28 patients, 27 women and 1 man, aged 28 to 72 years (mean age, 54.2 years), with Fitzpatrick Skin Types II to IV, were treated for mild to moderate actinic damage using fractional erbium:YAG laser (2,940 nm) combined with Pixel technology. Sessions were scheduled at 4-week intervals. Response to treatment was evaluated by two physicians on a five-tiered scale.
RESULTS Patients underwent one to four treatment sessions (mean, 3.2). The initial reaction consisted of erythema and minimal swelling. On clinical assessment 2 months after the final treatment, the results were rated excellent by 21 patients (75%) and good by 7 (25%). Nineteen of the 21 were also evaluated 6 to 9 months after final treatment without any significant change in the results.
CONCLUSIONS Fractional ablative photothermolysis using erbium:YAG laser (2,940 nm) is a promising option for skin resurfacing with reduced risk and downtime compared to existing laser methods.     

Treatment of nasal ala nodular congenital melanocytic naevus with carbon dioxide laser and Q-switched Nd:YAG laser

Total excision of congenital melanocytic nevi (CMN) is not always feasible. We here present our experience of using carbon dioxide laser and Q-switched neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser to treat nodular CMN of the nasal ala. Q-switched Nd:YAG laser and/or carbon dioxide laser were used to treat eight cases of nasal ala nodular CMN. Carbon dioxide laser was utilized to ablate all visible melanocytic tissue within one session. Ablation was performed so as to reproduce the original anatomical contours as closely as possible. Recurrences were treated in the same way. Q-switched Nd:YAG laser was also used to irradiate all target lesions to achieve the desired end point within one session. The intervals between treatments were at least 8 weeks. Recurrence of melanocytic tissue, scar formation, pigmentation, depigmentation, and the degree of patient satisfaction were recorded at every visit. Two of the eight patients were treated with Q-switched Nd:YAG laser. Although, the lesion lightened in one of them, the hyperplastic tissue persisted. Eventually, these two patients, along with the remaining six patients, were successfully treated with a carbon dioxide laser. We recommend carbon dioxide laser treatment for nodular nasal CMN. This simple treatment does not involve skin flap transplantation and has good cosmetic outcomes. Although Q-switched Nd:YAG laser does lighten some nasal nodular CMNs, it does not eradicate the hyperplastic tissue, and is therefore not an effective treatment for nodular nasal CMN.     

Single-Pass Carbon Dioxide Versus Multiple-Pass Er:YAG Laser Skin Resurfacing: A Comparison of Postoperative Wound Healing and Side-Effect Rates

BACKGROUND: Ablative laser skin resurfacing with carbon dioxide (CO2) and erbium:yttrium-aluminum-garnet (Er:YAG) lasers has been popularized in recent years and their side effects individually reported. No prior study, however, has directly compared the relative healing times and complications rates between the two different systems. OBJECTIVE: To evaluate and compare postoperative wound healing and short- and long-term side effects of single-pass CO2 and multiple-pass, long-pulsed Er:YAG laser skin resurfacing for the treatment of facial photodamage and atrophic scars. METHODS: A retrospective chart review and analysis of sequential clinical photographs were performed in 100 consecutive patients who underwent laser skin resurfacing with single-pass CO2 (Ultrapulse 5000; Coherent, Palo Alto, CA, N=50) or multiple-pass, long-pulsed Er:YAG laser resurfacing (Contour; Sciton, Palo Alto, CA, N=50). All laser procedures were performed by a single operator for the amelioration of facial rhytides or atrophic scars. The rate of re-epithelialization, duration of erythema, and presence of complications were tabulated. RESULTS: The average time to re-epithelialization was 5.5 days with single-pass CO2 and 5.1 days with long-pulsed Er:YAG laser resurfacing. Postoperative erythema was observed in all patients, lasting an average of 4.5 weeks after single-pass CO2 laser treatment and 3.6 weeks after long-pulsed Er:YAG laser treatment. Hyperpigmentation was seen in 46% of the patients treated with single-pass CO2 and 42% of the patients treated with the long-pulsed Er:YAG laser (average duration of 12.7 and 11.4 weeks, respectively). No incidences of hypopigmentation or scarring were observed. CONCLUSION: Skin resurfacing with single-pass CO2 or multiple-pass long-pulsed Er:YAG laser techniques yielded comparable postoperative healing times and complication profiles.     

A Retrospective Study on the Efficacy and Complications of Q-Switched Alexandrite Laser in the Treatment of Acquired Bilateral Nevus of Ota-Like Macules

BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNOM), or Hori's macules, is a common Asian condition that is characterized by bluish hyperpigmentation in the bilateral malar regions. Unlike nevus of Ota, ABNOM is an acquired condition that often develops after 20 years of age and involves both sides of the face, but there is no mucosal involvement. Recently Q-switched (QS) 1064 nm Nd:YAG lasers have been effective in clearing this condition. The effectiveness of QS alexandrite lasers has not yet been studied. OBJECTIVE: To retrospectively assess the efficacy and complications of QS alexandrite lasers in the treatment of ABNOM. METHODS: Thirty-two Chinese women with ABNOM ranging in age from 28 to 66 years were involved in the study. All underwent QS alexandrite laser treatment (755 nm, spot size 3 mm, 8 J/cm(2)). Topical hydroquinone and tretinoin cream were given to those with hyperpigmentation after the laser surgery. Clinical photographs were taken before and after laser surgery and assessed by two independent observers. The degree of clearing was scored and complications, including hypopigmentation, hyperpigmentation, scarring, and erythema, were assessed. RESULTS: The mean number of treatment sessions was 7 (range 2-11) and the mean treatment interval was 33 days. Both observers identified more than 80% of the patients as having more than a 50% degree of clearing, and complete clearance was seen in more than 28% of patients. Although most patients had postlaser hyperpigmentation and were on depigmentary regimes, the hyperpigmentation was seen in only 12.5% of the patients during photographic evaluation. Hypopigmentation was seen in 50% of patients and erythema in 41%. CONCLUSION: QS alexandrite appears to be effective in the treatment of ABNOM. Postoperative pigmentary changes were frequent and the use of topical depigmentary agents was necessary to achieve a satisfactory result. Transient hypopigmentation risk was high, affecting up to 50% of the patients. Further study is warranted to compare the efficacy and complications of different laser systems in the treatment of this condition.     

Congenital Spitz Nevus

BACKGROUND: Congenital Spitz nevus has been reported previously in the literature, but the histopathologic features have not been examined in detail. OBJECTIVE: To histologically examine and report on congenital Spitz nevus. METHOD: We examined 10 clinically submitted congenital melanocytic nevi that were histopathologically identified as congenital Spitz nevi and compared them to the characteristics seen in acquired Spitz nevus and superficial congenital melanocytic nevus. RESULTS: Of the 10 congenital Spitz nevi, 9 were compound and 1 was dermal. Two showed features of combined Spitz nevus (Spitz and blue). Six cases showed all 16 listed characteristics of acquired Spitz nevus, with two cases having 15 and two cases having 14 characteristics. Of the superficial congenital melanocytic nevus characteristics, all except three cases had all 12 attributes. The one dermal lesion had all the characteristics of the acquired Spitz nevus and all but one of the characteristics of the superficial congenital melanocytic nevus in regards to intradermal findings. CONCLUSIONS: Congenital Spitz nevi are true congenital lesions, with histopathologic features of both acquired Spitz nevus and superficial congenital melanocytic nevus.     

Treatment of Acquired Bilateral Nevus of Ota-Like Macules (Hori''s Nevus) with a Combination of the 532 nm Q-Switched Nd:YAG Laser Followed by the 1,064 nm Q-Switched Nd:YAG Is More Effective: Prospective Study

BACKGROUND: Acquired bilateral nevus of Ota-like macules (Hori's nevus) is a common dyschromatosis among Asian women. Q-switched lasers have been used successfully as a treatment modality. OBJECTIVE: The purpose of this study was to compare the efficacy of using the Q-switched 532 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser followed by the 1,064 nm laser versus the Q-switched 1,064 nm Nd:YAG laser alone in the treatment of Hori's nevus. METHODS: This is a prospective left-right comparative study. Ten women with bilateral Hori's nevus were recruited and treated with a combination of the Q-switched 532 and 1,064 nm Nd:YAG lasers on the right cheek and the Q-switched 1,064 nm Nd:YAG laser alone on the left cheek. Only one laser treatment session was performed. The degree of pigmentation was objectively recorded with a mexameter. Subjective assessment was made by both patients and two blinded, nontreating dermatologists. RESULTS: At 6 months, there was a statistically significant difference (p = .009) of 35.10 points using objective mexameter measurements between the two sides, favoring the side treated with a combination of 532 and 1,064 nm laser treatment. Subjective grading by the patients and blinded dermatologists also confirmed that combination therapy was more successful after one treatment. Although combination treatment had a higher incidence of mild postinflammatory changes, this disappeared within 2 months. CONCLUSIONS: Concurrent use of the Q-switched 532 nm Nd:YAG laser in combination with the 1,064 nm laser is more effective in pigment clearance than the Q-switched 1,064 nm Nd:YAG laser alone for Hori's nevi.     

Laser Hair Removal: Comparison of Long-Pulsed Nd:YAG, Long-Pulsed Alexandrite, and Long-Pulsed Diode Lasers

Background. Advances in laser technology over the past several years have led to the development of numerous lasers for the treatment of unwanted hair. Laser wavelength is a key factor influencing treatment efficacy and complication rates.
Objective. To compare the efficacy and safety of laser hair removal using three different laser systems.
Methods. A retrospective study of 805 consecutive laser-assisted hair removal treatments, conducted on 75 patients by means of either a long-pulsed Nd:YAG, a long-pulsed alexandrite, or a long-pulsed diode laser is reported. All patients were evaluated at least 3 months after the last treatment, and their present conditions were compared with the 1st-day photographs.
Results. The mean hair reduction was 42.4%, 65.6%, and 46.9% in Nd:YAG, alexandrite, and diode lasers, respectively. When the number of treatment sessions was taken into account, the efficacy of alexandrite and diode lasers was not significantly different, whereas both systems were more efficacious than Nd:YAG. Neither of the laser systems showed better results for a particular skin type. The occurrence of side effects was not significantly different between three laser systems.
Conclusion. Both long-pulsed alexandrite and long-pulsed diode laser systems are effective in the treatment of unwanted hair, and they are more efficacious than Nd:YAG laser.     

A Combination of Non-ablative Laser and Hyaluronic Acid Injectable for Postacne Scars: A Novel Treatment Protocol

BackgroundPostacne facial scars are often associated with significant patient distress. Energy-based devices, including non-ablative lasers, are commonly used for the treatment of postacne scarring. There is relatively limited data regarding the combination of non-ablative lasers with hyaluronic acid injections for postacne scarring.ObjectiveWe aimed to evaluate the efficacy of a non-ablative 1,540-nm erbium:glass laser combined with a hyaluronic acid injectable for the treatment of postacne scars.MethodsThis was a retrospective analysis of 12 patients who underwent the full treatment protocol. A before and after blinded clinical evaluation was performed independently by two dermatologists and graded on a scale from 0 (indicating a worsening of scarring) to 4 (indicating a 76–100% improvement in scarring). Pain perception, adverse effects, and patient satisfaction were evaluated.ResultsA mean correct blinded before and after evaluation by two dermatologists was 96 percent. Patients demonstrated mild to moderate improvement as assessed by a quartile scale of improvement (25–50%). Mild transient pain was reported by most patients. The satisfaction level of the patients was high (4 out of 5).LimitationsThe limitations of our study include the small cohort, retrospective design, and lack of a histological correlation.ConclusionOur results suggest that this combination treatment using 1,540-nm fractional erbium:glass laser and hyaluronic acid injections is both safe and effective for patients with postacne facial scars.     

Variable pulse erbium:YAG laser skin resurfacing of perioral rhytides and side-by-side comparison with carbon dioxide laser

BACKGROUND AND OBJECTIVE: Laser resurfacing of facial rhytides has become a popular treatment option for many patients with wrinkles, photoaging, and acne scarring. Laser wavelength/pulse duration options and new techniques continue to shorten the healing phase associated with laser skin resurfacing while maintaining clinical efficacy. Variable pulse erbium:YAG (Er:YAG) laser systems are now available that offer the surgeon the ability to vary the Er:YAG pulse duration from a pulse that is primarily ablative to one that is more thermal. The objective of this study was to evaluate the histologic effects created with a variable pulse Er:YAG laser. To study prospectively the clinical effects on upper lip rhytides with a variable pulse Er:YAG laser when compared side by side with pulsed carbon dioxide (CO(2)) laser resurfacing. STUDY DESIGN/MATERIALS AND METHODS: Forty-two treatment sites on 21 patients were randomized and evaluated after treatment of the upper lip region with CO(2) laser resurfacing on one side and a variable pulse Er:YAG laser on the other. Patient diaries were maintained to assess erythema, crusting, pain, and pigmentary changes. Blinded objective grading of improvement was performed. Chromometer measurements were obtained to analyze erythema. RESULTS: The variable pulse Er:YAG laser treatment reduced the duration of crusting on average from 7.7 days with CO(2) to 3.4 days. Chromometer measurements noted decreased postoperative erythema. Grading by physicians in a blinded manner showed 63% improvement for the CO(2) treatment site and 48% improvement in the variable pulse Er:YAG site. No cases of permanent hyperpigmentation, hypopigmentation, or scarring occurred. CONCLUSION: The variable pulse Er:YAG laser resurfacing is a safe and effective resurfacing tool, which combines ablative and thermal modalities. The protocol used in this study approaches but does not equal the results we have traditionally seen with CO(2) laser resurfacing.     

The Safety and Effectiveness of Single-Pass Erbium:YAG Laser in the Treatment of Mild to Moderate Photodamage

BACKGROUND: There are several treatment modalities for mild to moderate photodamage. The demand for effective treatments with minimal side effects has increased. OBJECTIVE: The objective of this study was to determine the effectiveness of short-pulsed erbium:YAG laser in treating mild to moderate photodamage. METHODS: Twenty patients were treated with the short-pulse erbium:YAG laser on the face and neck. One pass was given over the entire face with two to three passes over the perioral and periorbital regions. Patients were evaluated for improvement of pigmentary irregularities, skin texture, and fine wrinkles. All side effects were recorded at follow-up visits. Two lasers were used, Sciton and Cynosure CO3, under local anesthesia. RESULTS: There was a 58% reduction in pigment irregularities and a 54% improvement in skin texture. There was minimal improvement in fine wrinkles with one pass. Two and three passes resulted in a 50% reduction in wrinkles. The procedure was minimally painful. Side effects included 3 to 5 days of erythema and edema. Patients returned to work within 3 days on average. There were no infections. Patient satisfaction with the procedure was rated as very good. There was no difference in efficacy or adverse effects with either laser. CONCLUSIONS: One-pass short-pulse erbium:YAG laser in treating photodamage of the face and neck is safe and effective. There are minimal side effects and patients heal within 3 to 5 days.     

Comparative Evaluation of Long-Pulse Alexandrite and Long-Pulse Nd:YAG Laser Systems Used Individually and in Combination for Axillary Hair Removal

BACKGROUND The 755-nm alexandrite and the 1,064-nm Nd:YAG lasers are both utilized for hair removal. Advances in laser technology have led to the development of dual-wavelength treatment for increased efficacy.
OBJECTIVE The objective was to evaluate the safety and efficacy of combining 755- and 1,064-nm wavelengths for axillary hair removal.
METHODS Twenty patients received three treatments at 4- to 6-week intervals in four axillary quadrants. The left upper axilla was treated with the alexandrite laser, the left lower axilla with the Nd:YAG laser, the right upper axilla with combination alexandrite and Nd:YAG laser, and the right lower quadrant with the diode laser. At 1- and 2-month follow-up visits, subjects completed questionnaires and were assessed for percentage of hair reduction.
RESULTS Eighteen subjects completed the study. The greatest reduction was seen with the alexandrite laser at 70.3% and combination of alexandrite and Nd:YAG laser at 67.1%. The diode laser was less efficacious at 59.7% and the Nd:YAG laser had the least improvement with 47.4% reduction. Subjects found the alexandrite and diode lasers to be the most tolerable and the Nd:YAG and combination treatment to be the most painful.
CONCLUSION Combination treatment of alexandrite and Nd:YAG lasers provides no added benefit over the alexandrite laser alone.