Erbium Laser Resurfacing Research Articles

33327 A case of reed syndrome with an unusually extensive cutaneous burden

Reed Syndrome, or hereditary leiomyomatosis and renal cell carcinoma syndrome, is a rare, autosomal dominant genetic condition that predisposes individuals to a triad of cutaneous leiomyomas (CLMs), uterine leiomyomas and renal cell carcinoma. CLMs are often the first manifestation of the syndrome, occurring in 76% of patients typically in their second to fourth decade of life. CLMs are smooth-surfaced, reddish-brown papules or nodules that range 0.2 to 2.0 cm in diameter and average 25 in number. We present a case of a 47-year-old female with Reed syndrome with an unusually extensive cutaneous burden, with a total of 361 cutaneous lesions, far above the average reported number of 25. Due to the extent of her cutaneous burden, painful nature of the lesions and failure to respond to standard therapies, she was referred for fully ablative erbium laser resurfacing therapy. The use of fully ablative erbium laser resurfacing therapy for treatment of CLMs has not been reported in the literature to date. One year following laser therapy, the treatment area not only healed with normal repigmentation, but there was also no evidence of CLMs recurrence. Given the effectiveness of this unique therapy, fully ablative erbium laser resurfacing should be kept in mind as a treatment option for both cosmetic and symptomatic CLMs.

Combined Treatment of Rolling Acne Scars in Ethnic Skin Using Extensive Subcision, Trichloracetic Acid Peel, and Fractional Ablative Erbium Laser.

BACKGROUNDSuccessful treatment of acne scars in ethnic skin requires procedures that are safe and effective with a low incidence of hyper or hypopigmentation postoperatively.OBJECTIVEIn this study, the safety and efficacy of a combined treatment protocol including tumescent anesthesia, subcision, trichloracetic acid peel, and fractional erbium laser resurfacing was evaluated.METHODSThis is a retrospective study of 56 patients (22 women and 34 men) with predominantly rolling acne scars and Fitzpatrick skin Types IV–VI who were treated using a combination of tumescent anesthesia, extensive subcision, fractional ablative erbium laser, and a blending 20% trichloracetic acid (TCA) peel.RESULTSThe mean improvement after a single treatment, assessed by 3 independent evaluators (2 dermatologist and 1 dermatology physician assistant), was 2.52 (SD = 1.04) on a scale of 1 to 4.CONCLUSIONThe combination of tumescent anesthesia, extensive subcision, fractional ablative erbium laser resurfacing, and a blending 20% TCA peel (combined procedure) is both safe and effective in the treatment of rolling acne scars in ethnic skin types with acceptable temporary adverse effects.

Full-face skin resurfacing using a combination of fractional and full spot ablative 2940nm erbium laser.

Full-field deep ablative laser resurfacing is a popular method for skin rejuvenation due to maximum improvement in a single treatment. However, it is associated with disadvantages such as pain, prolonged erythema, swelling, crusting, infections, pigmentary changes, and scarring. Patients are increasingly seeking less invasive options with comparable effect. The aim of this retrospective study was to evaluate the safety and efficacy of full-face resurfacing using a combination of full spot and fractional erbium (Er:YAG) laser resurfacing. About 109 patients, mostly females over 50years old, were treated with a two-phase protocol: full spot ablation (5J/cm2 , three passes) and fractional ablation (132J/cm2 , 5% coverage, three passes). We recorded time to re-epithelization and duration of post-treatment erythema. Any side effects observed at follow-up or reported by the patient were recorded. Patient satisfaction questionnaire and blinded evaluation of pre- and post-treatment photographs were used to assess efficacy. A single session was performed in 96% of cases. Postoperative re-epithelization lasted on average 6.4±2.9days. Post-treatment erythema lasted on average 13.8±15.2days. One patient had hyperpigmentation, one infection, one hypo-pigmentation, and one ulcer. All side effects resolved without complications. According to the blinded assessment of photographs, 78% of patients showed improvement. About 97% of patients were satisfied with the results of the treatment. A combination of fractional and full spot ablative Er:YAG laser is a safe and effective option for full-face resurfacing.

Observations on the Tear Trough.

The tear trough is a prominent structure of the midface. Many surgical and nonsurgical techniques have been devised to efface this feature. The aim of this study was to define an aesthetically pleasing tear trough and understand the effect of various surgical procedures on its appearance. We undertook a retrospective review of "ideal" subjects (ie, young men and women as well as male and female models) as well as surgical patients undergoing lower blepharoplasty with fat excision, fat transposition, erbium laser resurfacing of the eyelids and midface, or endoscopic midface lifting. Marginal reflex distance-2, lower eyelid length, and nasojugal fold depth were measured and analyzed for all patients. The nasojugal fold was significantly less prominent in ideal female models than in all other groups (P < 0.0001). Lower eyelid length was significantly shorter after fat excisional lower blepharoplasty, laser resurfacing, and midface lift (P < 0.0001), and did not change after fat transpositional lower blepharoplasty. Postsurgical reduction in lower eyelid length was significantly less with fat transpositional lower blepharoplasty than in all other groups (P < 0.0001). The nasojugal fold was significantly effaced after all types of procedures (P < 0.0001), but was significantly more effaced after fat transpositional lower blepharoplasty (P < 0.01) than after all other procedures. A slight, medial tear trough is present in youth in many patients. The clinical tear trough is a virtual topographic structure distinct from the anatomic tear trough ligament and can be altered in a variety of ways.

Comparison of a novel wound dressing vs current clinical practice after laser resurfacing

There are many postprocedure skin care options, but no consensus on the best formulation to optimize healing. Silicone gels have only been used to treat keloids and hypertrophic scars and typically applied after the wound has healed. This study compared the healing response after fractional ablative erbium laser resurfacing with a petrolatum-based ointment and a silicone gel. A randomized, open-label, split-face study was performed. Ten subjects underwent Erbium:YAG (Sciton) fractional laser resurfacing. Patients were randomized to apply a petrolatum-based gel or a silicone gel (Stratacel® ; Stratpharma) on either the right or left side of the face. Subjects applied the products twice a day for 7days and were evaluated in person 7, 30, and 60days postprocedure. Subjects reported on the overall general aesthetic outcome, perceived pain, itch, and tightness via questionnaires using the Global Aesthetic Improvement Scale and the Wrinkle Severity Rating Scale (WSRS). All subjects healed without complications. By day 60, there was no difference in signs and symptoms of healing between the two different dressing approaches. However, patients treated with the silicone gel had less post-treatment erythema and hyperpigmentation. A novel silicone gel resulted in reduced signs of erythema and hyperpigmentation postprocedure, without an increase in adverse events. Additionally, the silicone gel dries to form a thin, full contact film and can be covered with sunscreen or cosmetics once dry. This new silicone gel presents a good option for postprocedure care after ablative fractional laser resurfacing.

Long-Term Assessment of Perioral Rhytide Correction with Erbium: YAG Laser Resurfacing.

Use of nonsurgical skin rejuvenation has grown over the past two decades. This has led to an increase in ablative and nonablative resurfacing devices. Moderate to heavy perioral rhytides require an ablative laser to maximize results. Traditionally, this was performed with carbon dioxide lasers; however, more recently, erbium lasers have been used to target heavy rhytides. The purpose of this study was to assess long-term correction of perioral rhytides with the use of the senior author's (A.J.B.) erbium laser resurfacing technique. A retrospective review of all patients who underwent perioral erbium laser resurfacing performed by the senior author from 2009 to 2016 with a minimum of 6-month follow-up was performed. Ten blinded nonphysicians and 10 blinded plastic surgeons evaluated the imaging based on a previously established standardized grading sheet, with gradation improvement from 1 to 8. The absolute and percentage improvement were evaluated, along with complications. Forty-five patients met inclusion criteria, with an average follow-up of 13 months. A statistically significant score improvement of 2.2 gradations was seen, in addition to a significant improvement (from 56 percent to 66 percent). Both the surgeon and nonphysician groups showed improvement, with no differences between the two groups. There were no cases of hypopigmentation at the 6-month postoperative visit. Erbium laser resurfacing is a powerful and safe tool for correcting perioral rhytides. It is effective in isolation or with other facial rejuvenation procedures. Erbium laser resurfacing is a useful adjunct in facial rejuvenation that can deliver exceptional results with few complications when performed within the proper guidelines. Therapeutic, IV.

Effect topical hyaluronic acid after ablative fractional erbium laser resurfacing for lip rejuvenation

Effect topical hyaluronic acid after ablative fractional erbium laser resurfacing for lip rejuvenation

Noninvasive skin measurements after CO and erbium laser resurfacing

Noninvasive skin measurements after CO and erbium laser resurfacing

Noninvasive skin measurements after CO 2 and erbium laser resurfacing

Background: Improvement in skin after laser resurfacing depends on treatment to a precise level. The target treatment level will depend on skin type, anatomic location, and severity of the presenting problem. The development of noninvasive skin measurements that correlate with histologic changes wouldn provide a useful intraoperative guide for treatment. Objective: The relationship among different types of lasers and levels of applied energy; objective real-time noninvasive measures of the skin; and histologic condition were studied in an attempt to gain information that could aid in achieving safer and more predictable laser skin resurfacing. Methods: The paraspinal skin of Yorkshire hybrid pigs was used for the study. In pig 1, study sites were treated with the Ultrapulse CO 2 laser (Coherent, Inc, Santa Clara, CA) with the CP-G at 300 ml for 0 to 5 passes. The Sciton Contour erbium:YAG llaser (Contour, Sciton, Palo Alto, CA) set at 200 μm of pure ablation was used to treat a separate but adjacent area for 0 to 5 passes. Treated sites and control sites were evaluated by measurements of biomechanical properties, digital imaging, and barrier integrity. In pig 2, the study was repeated with the Sciton Contour erbium:YAG laser at 10 different energy levels. Full-thickness punch biopsy specimens were obtained immediately after treatment and correlated with the biomechanical measures. Results: After the third pass with the CO 2 laser, there was no additional tissue ablation or change in surface biophysical measurements. There was an apparent increase in inflammation in the lower dermis with passes 4 and 5 seen on day 2 biopsies that suggested deeper thermal effects. The erbium laser continued to ablate with increasing applied energy. The change in viscoelastic creep correlated with the laser energy applied and inversely correlated with the remaining dermal depth of the skin after laser treatment. Conclusions: The measurement of immediate changes in iviscoelastic creep should be further studied as a means of guiding intraoperative erbium laser resurfacing. Histologic evaluation suggests that the erbium:YAG laser may be a more effective tool for dermal ablation than the CO 2 laser.

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.

Resurfacing of photodamaged skin on the neck with an UltraPulse((R)) carbon dioxide laser.

Successful treatment of facial wrinkles with carbon dioxide or erbium laser resurfacing brings about a more youthful appearance of the skin on the face. A variable degree of contrast with the untreated skin on the neck prompts many patients to request treatment for photodamaged skin on the neck. The objective is to investigate the feasibility of resurfacing photodamaged skin on the neck with the UltraPulse((R)) carbon dioxide laser. SUDY DESIGN/MATERIALS AND METHODS: The study was carried out in two phases. During the first phase, a small area on the upper neck was tested with three different parameters. The best parameter was then used to treat the neck area in a single pass in 10 cases in the second phase. Patients were then evaluated at 3-6 months. The three parameters tested were 200 mJ at CPG settings of pattern 3, size 9, density 6, 300 mJ at CPG 3-9-5, and 300 mJ at CPG 3-9-6. The latter seemed to achieve the best results, and there were no complications at any test sites. This setting was used to treat the whole anterior and anterolateral part of the neck with a single pass, wiping away the resultant epidermal debris. Moderate improvement in color and texture, but no improvement in wrinkling, were observed at 3-6 months. However, a mild degree of patchy hypopigmented scarring in the lower neck was encountered in three cases, as well as one other case of patchy hypopigmentation without textural changes. Despite some obvious improvements, the risk of scarring and hypopigmentation with the tested parameters out-weighs the potential benefits. The lower part of the neck responded very differently from the upper part. Alternative strategies to achieve better results are discussed.

Postoperative Laser Care

Postoperative laser care is critical to the successful performance of CO2 and erbium laser resurfacing. Anticipation and prevention of postoperative problems and complications leads to greater patient satisfaction and fewer permanent sequalae. In most situations, a team approach, with the use of trained nurses and aestheticians, ensures greater success in this critical postoperative period. Laser resurfacing is one of the few procedures in which the surgery is only beginning when the surgeon leaves the operating suite.

Chemical injury to the eye from EMLA cream during erbium laser resurfacing.

EMLA cream is commonly used as a topical anesthetic by physicians performing dermatologic surgery. The purpose of this article is to inform physicians that EMLA cream is highly alkaline and can be particularly toxic to the eye. Symptoms of eye irritation may be initially masked because of local anesthetic effects. Two patients are described who developed corneal abrasions from inadvertent exposure of the eye to EMLA cream prior to erbium laser resurfacing. The patients developed corneal abrasions and conjunctivitis, consistent with chemical alkaline burns. EMLA cream should be used with extreme caution near the eye and probably should be avoided when there is a need to insert laser eye shields.

Erbium Laser Resurfacing: Current Concepts

Erbium Laser Resurfacing: Current Concepts

Erbium laser resurfacing: current concepts.

Laser skin resurfacing has enjoyed great popularity in recent years with the introduction of computerized, pulsed carbon dioxide lasers. However, the morbidity and side effects of carbon dioxide lasers have stimulated a search for alternative methods of skin remodeling. The erbium:YAG laser can be successfully used for skin resurfacing, with lower morbidity than the carbon dioxide laser. In a series of 625 patients who had erbium:YAG resurfacing, the following conclusions were reached. (1) Long-term (> 6 months) improvement in wrinkles and acne scars required total fluences exceeding 20 J/cm2. Periocular wrinkles required total fluences of between 20 and 40 J/cm2, depending on the depth of the wrinkles and skin thickness. Perioral rhytids required total fluences of between 40 and 80 J/cm2, whereas the cheeks and forehead required total fluences of 30 to 60 J/cm2. (2) Deeper wrinkles were best treated with a combination of erbium and carbon dioxide lasers, which minimized the bleeding that occurs with deeper erbium resurfacing. The simultaneous combined erbium with carbon dioxide laser was particularly advantageous. (3) Complications were relatively uncommon using the scanning erbium laser, and most adverse effects occurred early in the series. Scarring occurred in 5 of the 625 patients (0.8 percent) and mostly resolved with intralesional steroids. Hyperpigmentation occurred in 21 of the 625 patients (3.4 percent) and was temporary in nature. Hypopigmentation, which became evident after 6 months, occurred in 25 of the 625 patients (4.0 percent) but was mild and not a significant cosmetic problem, except in one patient who developed scarring on the neck. Hypopigmentation seemed to be related to the depth of resurfacing. Four of the 625 patients (0.6 percent) developed temporary scleral show, but no patients had permanent ectropion. Eight of the 625 (1.3 percent) developed synechiae under the lower eyelid, which required minor correction.

Basic physics of erbium laser resurfacing.

The rapid growth in erbium laser resurfacing gives rise to a need for clinicians to become familiar with some new terminology and concepts. The design of erbium laser machines used for these procedures is described giving clinicians a basis for machine selection. The basic concepts of energy, fluence and overlap will allow the clinician to manipulate the laser parameters so as to achieve the desired clinical results.