Fractional Er Research Articles

The effect of pulse duration, power and energy of fractional Er:YAG laser for transdermal delivery of differently sized FITC dextrans

We studied fractional Er:YAG laser to enhance transdermal drug delivery of compounds possessing different molecular weights: FITC-dextrans (or FD) with average molecular weights of 4, 10 and 20kDa. Vertical glass Franz diffusion cells were used to study molecular transport through dermatomed porcine skin and histological analysis of laser-treated skin was performed after treatment with different laser pulse protocols. We were comparing different pulse durations at constant or varying pulse energies. We found that the energy of the delivered pulses mostly dictates the size/depth of laser-created microchannels, while the duration of the pulses dictates the extent of thermally altered tissue. That is, tissue ablation threshold is lowered at shorter pulse durations with higher power, which is preferred as it lowers thermal effects on viable skin layers. Especially for smaller molecules, transdermal delivery is increased by increasing laser-created microchannel size, but also by making partitioning into tissue easier when less thermal damage is caused on tissue. For large molecules, molecular transport through the remainder of skin tissue becomes increasingly difficult regardless of laser pulse parameters.

Comparison between Er:YAG laser and bipolar radiofrequency combined with infrared diode laser for the treatment of acne scars: Differential expression of fibrogenetic biomolecules may be associated with differences in efficacy between ablative and non‐ablative laser treatment

Fractional Er:YAG minimizes the risk associated with skin ablation. Infrared diode laser and radiofrequency have suggested comparable improvements in acne scar. We compared the clinical efficacy of Er:YAG laser and bipolar radiofrequency combined with diode laser (BRDL) for the treatment of acne scars. Moreover, acute molecular changes of cytokine profile associated with wound healing have been evaluated to suggest mechanisms of improvement of acne scar. Twenty-four subjects with mild-to-moderate acne scars were treated in a split-face manner with Er:YAG and BRDL, with two treatment sessions, 4 weeks apart. Objective and subjective assessments were done at baseline, 1, 3, 7 days after each treatment and 4 weeks after last treatment. Skin biopsy specimens were obtained at baseline, 1, 3, 7, 28 days after one session of treatment for investigation of molecular profile of acute skin changes by laser treatment. Investigator's Global Assessment representing the improvement degree shows 2.1 (50%) in fractional Er:YAG and 1.2 (25%) in BRDL. Er:YAG induced the later and higher peak expression of TGFβs and collagenases, whereas BRDL induced earlier and lower expression of TGFβ and collagenases, relatively. PPARγ dropped rapidly after a peak in Er:YAG-treated side, which is associated with tissue inhibitor of metalloproteinase (TIMP) expression. We observed higher expression of TIMP after Er:YAG treatment compared with BRDL by immunohistochemistry, which may be associated with the expression of upregulation of collagen fibers. The superior efficacy of Er:YAG to BRDL in the treatment of acne scars may be associated with higher expression of collagen which is associated with differential expression of TGFβs, collagenases, PPARγ, and TIMP. Lasers Surg. Med. 49:341-347, 2017. © 2016 Wiley Periodicals, Inc.

Combination therapy for onychomycosis using a fractional 2940-nm Er:YAG laser and 5% amorolfine lacquer.

Onychomycosis remains difficult to cure by traditional methods. The aim of this study was to evaluate the efficacy of combination therapy with a fractional erbium yttrium aluminum garnet (Er:YAG) laser and 5% amorolfine lacquer on onychomycosis. Nine patients with bilateral nails affected by distal and lateral subungual onychomycosis were included. The bilateral nails of each patient were divided into two groups. The 20 affected nails on one side of each patient as group 1 were treated with a fractional Er:YAG laser once a week and 5% amorolfine lacquer twice weekly, while the 20 nails on the symmetrical side of each patient as group 2 were treated with amorolfine lacquer only. The laser treatment was conducted at weeks 1, 2, 3, 4, 8, and 12 in group 1. The clinical improvement, onychomycosis severity index (OSI), maximum linear clear nail growth (MLCNG), and mycological cure rate were evaluated. At week 24, 18 of 20 (90%) nails in group 1 had achieved obvious clinical responses. The mean OSI score showed a significant decrease (5.24) and the average MLCNG was 3.1mm in group 1. At week 24, 15 of 20 (75%) nails achieved a negative mycological examination in group 1, compared with four of 20 (20%) nails in group 2. The treatments were well-tolerated by most patients. This clinical study suggests that combination therapy of a fractional 2940-nm Er:YAG laser and 5% amorolfine lacquer is an effective, safe, and convenient treatment method for onychomycosis.

Skin healing and collagen changes of rats after fractional erbium:yttrium aluminum garnet laser: observation by reflectance confocal microscopy with confirmed histological evidence.

The fractional erbium:yttrium aluminum garnet (Er:YAG) laser is widely applied. Microstructural changes after laser treatment have been observed with histopathology. Epidermal and dermal microstructures have also been analyzed using reflectance confocal microscopy (RCM). However, no studies have compared these two types of microstructural changes in the same subject at multiple time points after irradiation, and it is unclear if these two types of changes are consistent. We use RCM to observe the effect of different laser energies on skin healing and collagen changes in the skin of Sprague-Dawley rats that had been irradiated by fractional Er:YAG lasering at different energies. RCM was used to observe skin healing and detect collagen changes at different time points. Collagen changes were observed using hematoxylin and eosin (H&E) staining and quantitatively analyzed by western blot. RCM showed that, irrespective of laser energy, microscopic treatment zones (MTZs) were larger at 1day after irradiation. The MTZs then reduced in size from 3 to 7days after irradiation. The higher the energy, the larger the MTZ area. The amount of collagen also increased with time from 1day to 8weeks. However, the increase in the collagen amount on both RCM and H&E staining was not influenced by the laser energy. Western blotting confirmed that the amount of type I and type III collagens increased over time, but there were no significant differences between the different energy groups (p > 0.05). In conclusion, RCM is a reliable technique for observing and evaluating skin healing and collagen expression after laser irradiation.

Ablative fractional laser enhances MAL-induced PpIX accumulation: Impact of laser channel density, incubation time and drug concentration

Background and ObjectivesPretreatment of skin with ablative fractional laser enhances accumulation of topical provided photosensitizer, but essential information is lacking on the interaction between laser channel densities and pharmacokinetics. Hence our objectives were to investigate how protoporphyrin accumulation was affected by laser densities, incubation time and drug concentration. MethodsWe conducted the study on the back of healthy male volunteers (n=11). Test areas were pretreated with 2940nm ablative fractional Er:YAG laser, 11.2mJ per laser channel using densities of 1, 2, 5, 10 and 15% (AFL 1–15%). Control areas received pretreatment with curettage or no pretreatment. Methyl aminolevulinate (MAL) was applied under occlusion in concentrations of 0, 80 and 160mg/g. MAL-induced protoporphyrin fluorescence was quantified with a handheld photometer after 0, 30, 60, 120 and 180min incubation. The individual fluorescence intensity reached from the highest density (15%) and longest MAL 160mg/g incubation time (180min) was selected as reference (100%) for other interventional measurements. ResultsA low laser density of 1% markedly enhanced fluorescence intensities from 34% to 75% (no pretreatment vs. AFL 1%, MAL 160mg/g, 180min; p<0.001). Furthermore, fluorescence intensities increased substantially by enhancing densities up to 5% (p≤0.0195). Accumulation of protoporphyrins was accelerated by laser exposure. Thus, laser exposure of 5% density and a median incubation time of 80min MAL (range 46–133min) induced fluorescence levels similar to curettage and 180min incubation. Furthermore, MAL 80 and 160mg/g induced similar fluorescence intensities in skin exposed to laser densities of 1, 2 and 5% (p>0.0537, 30–180min). ConclusionMAL-induced protoporphyrin accumulation is augmented by enhancing AFL densities up to 5%. Further, this model indicates that incubation time as well as drug concentration of MAL may be reduced with laser pretreatment.

A prospective, randomized, double-blind comparison of an ablative fractional 2940-nm erbium-doped yttrium aluminum garnet laser with a nonablative fractional 1550-nm erbium-doped glass laser for the treatment of photoaged Asian skin

Background: As compared with ablative fractional CO2 laser, ablative fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser is considered to be a more suitable treatment option for photoaged skin in Asians due to the lower incidence of postinflammatory hyperpigmentation. Objective: To compare the efficacy and safety of ablative fractional Er:YAG laser (ablative fractional resurfacing [AFR]) and nonablative fractional 1550-nm Er:glass laser (non-AFR [NAFR]) in the treatment of photoaging. Methods: This was a prospective, randomized, double-blinded comparative study. In three sessions, at four-week intervals, 19 patients received Er:YAG AFR, and 15 patients received Er:glass NAFR. Pigmentation, uneven tone/erythema, wrinkles and overall features of photoaging were scored. Patient satisfaction, adverse effects and pain scores were recorded. Melanin and erythema indexes were measured. Results: Reductions in pigmentation and uneven tone/erythema scores were significantly greater after Er:YAG AFR, while wrinkle score reduction was significantly greater after Er:glass NAFR. Physician and patient assessments for the overall features showed greater improvement in the Er:glass NAFR. Treatment-related pain or adverse events were less in the Er:YAG AFR. Conclusion: Both Er:YAG AFR and Er:glass NAFR are effective and safe and could be used in a complementary manner for treating photoaged Asian skin.

Multi-beam laser-induced hydrodynamic shock waves used for delivery of microparticles and liquids in skin.

Laser radiation is often used to provide micro and nanoparticle delivery into the skin for medical and cosmetic purposes. This technique inherently has limited speed and effective penetration. We proposed and investigated a new method of rapid delivery of solid microparticles, nanoparticles and liquids into tissue through multiple microchannels created by a fractional laser microablation (FLMA) using Er:YAG-laser. The dependence of microchannel depth on laser pulse temporal structure and number of pulses and dermal coloration changes are studied in this paper. Microchannels created in the porcine skin in vitro by a fractional Er:YAG-laser were used to deliver Zirconium oxide (ZrO2) microparticles or hydrocortisone solution. Each laser pulse consisted of subpulses. Number of laser pulses (Np) and subpulses (Nsp) can be adjusted. The enhancement of delivery is expected due to hydrodynamic impact of laser pulse on the layer of the aqueous suspension of the particles or hydrocortisone solution placed on the skin surface. For color investigation, we used standard CIE Lab parameter analysis. The relationship between microchannel depth in the skin and number of laser pulses and subpulses was established. We found that free filling of microchannels with ZrO2-particle suspension has a low speed of ∼4 × 10(-5) mm/s. Particle delivery into microchannels induced by the hydrodynamic shock waves generated by Er:YAG-laser pulses is carried out with a high speed of 28.5 mm/s. We also found that skin color at ZrO2 -particle delivery differs from color of the intact skin, namely: the parameter L, which characterizes the "lightness" increased by 9 ± 1%; parameter a, which characterizes the "redness" decreased by 38 ± 4%; and parameter b, which characterizes the "yellowness" decreased by 21 ± 2%. The effective delivery of hydrocortisone was demonstrated using fluorescence method technique. Multi-beam laser-induced hydrodynamic shock waves generated by Er:YAG-laser pulses on the layer of the aqueous suspension of the particles or solution of a high molecular weight drug placed on the skin can be used for their rapid delivery into the skin.

Efficacy of minimal ablative fractional Er: YAG laser in the treatment of acne scars: A retrospective study

Efficacy of minimal ablative fractional Er: YAG laser in the treatment of acne scars: A retrospective study

Ablative fractional laser alters biodistribution of ingenol mebutate in the skin.

Topically applied ingenol mebutate (IngMeb) is approved for field-treatment of actinic keratosis and is currently being investigated for treatment of non-melanoma skin cancer (NMSC). Ablative fractional lasers (AFXLs) generate microscopic ablation zones (MAZs) in the skin, which may help induce a deep penetration needed for effective treatment of NMSC. Using Franz diffusion cells, uptake and bio-distribution were investigated over 21 h in intact (n = 9) and AFXL-exposed porcine skin (n = 58). A 2940-nm fractional Er:YAG laser generated intraepidermal (11.2 mJ/MAZ; 66 μm deep, 177 μm wide) and intradermal (128 mJ/MAZ; 570 μm deep, 262 wide) MAZ's with 16, 97, and 195 MAZs/cm(2). Surface ablation densities corresponded to 0.5, 2.5, and 5 % for intraepidermal MAZs, and corresponded to 1, 5, and 10.5 % for intradermal MAZs. Liquid-chromatography-mass-spectrometry quantified deposition of IngMeb in stratum corneum, epidermis, dermis, and receiver chamber. In intact skin, IngMeb readily penetrated to the epidermal layer (1,314 ng, 41 % of the applied IngMeb), while dermal deposition was limited (508 ng, 16 %). In AFXL-exposed skin, a profound dermal deposition of IngMeb was achieved, while less accumulated in SC and epidermis. Uptake depended entirely on laser density; increasing coverage from 0 % to 0.5 %, 1 %, 2.5 %, 5 %, and 10.5 % enhanced dermal uptake 1.6-, 2.1-, 3.1-, 3.4-, and 3.9-fold, respectively (p < 0.0001). Channel depth did not influence drug uptake; at 5 % density, dermal deposition with intraepidermal and intradermal MAZs was analogous (1801 vs. 1744; p = 0.447). In conclusion, IngMeb readily distributes to superficial layers of intact skin, whereas dermal uptake is limited. Independent of channel depth, AFXL enhances dermal drug deposition, providing for customized topical delivery and potential use of IngMeb for treatment of NMSC.

Usefulness of Skin Explants for Histologic Analysis after Fractional Photothermolysis.

BackgroundFractional laser resurfacing treatment has been extensively investigated and is widely used. However, the mechanism underlying its effects is poorly understood because of the ethical and cosmetic problems of obtaining skin biopsies required to study the changes after laser treatment.ObjectiveTo evaluate the usefulness of human skin explants for the investigation of fractional photothermolysis.MethodsFull-thickness discarded skin was treated in 4 ways: no treatment (control), fractional carbon dioxide laser, fractional Er:YAG laser, and fractional 1,550-nm erbium-doped fiber laser. Both treated and non-treated skin samples were cultured ex vivo at the air-medium interface for 7 days. Frozen tissue was sectioned and stained with hematoxylin & eosin for histologic examination and nitro blue tetrazolium chloride for viability testing.ResultsSkin explants cultured for up to 3 days exhibited histologic changes similar to those observed in in vivo studies, including microscopic treatment zones surrounded by a thermal coagulation zone, re-epithelialization, and formation of microscopic epidermal necrotic debris. However, the explant structure lost its original form within 7 days of culture. The viability of skin explants was maintained for 3 days of culture but was also lost within 7 days.ConclusionThe skin explant model may be a useful tool for investigating the immediate or early changes following fractional photothermolysis, but further improvements are required to evaluate the long-term and dermal changes.

Histologic comparison of microscopic treatment zones induced by fractional lasers and radiofrequency

Introduction: Fractional photothermolysis induces microscopic, localized thermal injury in the skin surrounded by undamaged viable tissue in order to promote wound healing. Objective: This study evaluated acute histologic changes following each single pass of various fractional lasers and radiofrequency (RF). Methods: Three male domestic swine were used. We used fractional Erbium:glass (Er:glass), Erbium:yttrium-aluminum-garnet (Er:YAG), CO2 lasers, and fractional ablative microplasma RF. We analyzed features and average values of the diameter, depth, and vertical sectional areas treated with each kind of laser and RF. Results: The microscopic treatment zone (MTZ) of fractional Er:glass resulted in separation of dermoepidermal junction with no ablative zone. Fractional Er:YAG provided the most superficial and broad MTZ with little thermal collateral damage. Fractional CO2 resulted in a narrow and deep “cone”-like MTZ. Fractional RF resulted in a superficial and broad “crater”-like MTZ. Conclusions: This study provides the first comparison of MTZs induced by various fractional lasers and RF. These data provide basic information on proper laser and RF options. We think that these findings could be a good reference for information about fractional laser-assisted drug delivery.

Multiple fractional erbium: yttrium–aluminum–garnet laser sessions for upper facial rejuvenation: clinical and histological implications and expectations

Fractional photothermolysis is a modern resurfacing technique, in which microscopic zones of thermal injury are created, stimulating turnover of both epidermis and dermis. Fractional laser rejuvenation has been developed to overcome the drawbacks of traditional ablative laser. To objectively evaluate the effectiveness of multiple sessions of fractional Er:YAG laser rejuvenation for aging upper face clinically, histologically and immunohistochemically. Ten volunteers asking for facial rejuvenation were subjected to multiple sessions (3-5) of fractional Er:YAG laser. Clinical evaluation with both histopathological and immunohistochemical assessment for skin biopsies was carried out before, after 1month and 6months of laser resurfacing. Histometry for epidermal thickness and quantitative assessment for neocollagen formation, collagen I, III, and VII, elastin and tropoelastin were carried out for all skin biopsies. Comparing before, after 1month and 6months of fractional Er:YAG laser resurfacing resulted in improved clinical appearance with increased epidermal thickness (P<0.001). Dermal collagen showed increased neocollagen formation (P=0.006), with increased concentration of collagen types I (P<0.001), III (P<0.001), and VII (P=0.001). Dermal elastic tissue studies revealed decreased elastin, while tropoelastin concentration increased after laser resurfacing (P<0.001). An increase in collagen (I and III) and tropoelastin level and decreased elastin content was encountered with increasing the number of sessions, yet it was not significant. Multiple sessions are effective in rejuvenation of the aging face with high safety, short downtime, and no adverse effects. They stimulated formation of new collagen (type I, III, and VII) up to 6months after treatment with better improvement in skin texture and fine wrinkles. The variable number of fractional Er:YAG laser sessions (3-5) showed no significant difference as regards efficacy.

Combination ALA‐PDT and ablative fractional Er:YAG laser (2,940 nm) on the treatment of severe acne

Scarring is a very common complication of severe acne and is difficult to treat by conventional methods. 5-Aminolevulinic acid (ALA) photodynamic therapy (PDT) is a novel treatment for improving acne lesions. Fractional laser resurfacing is a promising treatment for scar treatment because of its unique ability to stimulate the wound healing response and its depth of penetration. To evaluate the efficacy of combination therapies of ALA-PDT and ablative fractional Er:YAG laser (2,940 nm) for scarring lesions in severe acne patients. A prospective, single-arm, pilot study. Forty subjects with severe acne were treated with 15% ALA-PDT for four times at 10-day intervals. They then received ablative fractional Er:YAG laser treatment five times at 4-week intervals. Three independent investigators evaluated subject outcomes at 1, 3, 6, and 12 months post-treatment (primary outcome); patients also provided self-assessments of improvement (secondary outcome). Significant reductions in acne score (P < 0.01) were obtained at follow-up visits after 1, 3, 6, and 12 months. After 6 month, the lesions showed overall improvement in all of subjects (good to excellent in acne inflammatory lesions), 80% overall improvement in acne scars. After 12 months, most of subjects had improved hypertrophic/atrophic scars (good to excellent in 85%) and no one had recurrent acne inflammatory lesions. Patient self-evaluation also revealed good to excellent improvements (on average) in acne lesions and scarring, with significant improvements in self-esteem after 6 months post-treatment. PDT can control the inflammation and improve the severity of acne lesions. Fractional resurfacing is a promising new treatment modality for scars by stimulating wound healing and remodeling. The combination therapy is a promising option for severe acne to prevent and improve car formation.

Lachgas-Sauerstoff-Inhalation zur Analgesie in der ästhetischen Dermatologie

Local anaesthesia often is insufficient for more extensive procedures. Instead of general anaesthesia or sedation, pediatricians, gynaecologists and dentists increasingly use nitrous oxide (N2O). This study evaluates the suitability of this form of anesthesia in dermatology. In 24 patients (18 w, 6 m, mean age 49 y.) N2O/O2 inhalation (Livopan®) was used during 46 procedures with indications including fractional RF/wrinkle reduction, IPL/rosacea, q-sw. laser/tattoos and hemosiderosis as well as fractional Er:Glass laser for scars and hypopigmentation. In 26 procedures subjective pain intensity was measured (visual analogue scale 0-10). With N2O the treatment pain was lowered from 6.6 ± 1.6 to 2.9 ± 1.7 (median, p = 0.000). 23/24 patients chose N2O for their next treatment. Beside euphoria, fatigue, slight drowsiness, dizziness, nausea or change in auditory perception, no other side effects occurred. The pronounced analgesia, the easy self-administration, the fast onset and complete recovery after a few minutes and the low ratio of side effects make the N2O/O2 inhalation to an ideal addendum in the management of larger painful procedures in dermatology as long as contraindications and safety precautions are respected.

Comparison of Fractional Erbium-Doped Yttrium Aluminum Garnet and Carbon Dioxide Lasers in Resurfacing of Atrophic Acne Scars in Asians

The efficacy of fractional erbium-doped yttrium aluminum garnet (Er:YAG) and carbon dioxide (CO(2) ) lasers are well substantiated. To compare the efficacy and safety of these two laser systems for treatment of atrophic scars in dark-skinned patients. Twenty-four subjects with acne scars were randomly treated with a fractional Er:YAG laser on one side and a fractional CO(2) laser on the other side. All subjects received two treatments with a 2-month interval. Objective and subjective assessments were obtained at baseline and 1, 3, and 6months after the final treatment. At the 6 month follow up, 55% and 65% of Er: YAG and CO(2) laser sites, respectively, were graded as having more than 50% improvement of scars. Improvement progressed significantly from 1- to 6-month follow-up (p<.001). There was no significant difference in clinical improvement between the two systems at 1- (p=.90), 3- (p=.54), and 6-month (p=.87) follow-up. Reduction in scar volume corresponded to clinical evaluation. Fractional Er:YAG and CO(2) lasers provided comparable outcomes of scar treatment, but fractional CO(2) laser was associated with greater treatment discomfort.

Fractional versus ablative erbium:yttrium-aluminum-garnet laser resurfacing for facial rejuvenation: An objective evaluation

Laser is one of the main tools for skin resurfacing. Erbium:yttrium-aluminum-garnet (Er:YAG) was the second ablative laser, after carbon dioxide, emitting wavelength of 2940 nm. Fractional laser resurfacing has been developed to overcome the drawbacks of ablative lasers. We aimed to objectively evaluate the histopathological and immunohistochemical effects of Er:YAG 2940-nm laser for facial rejuvenation (multiple sessions of fractional vs single session of ablative Er:YAG laser). Facial resurfacing with single-session ablative Er:YAG laser was performed on 6 volunteers. Another 6 were resurfaced using fractional Er:YAG laser (4 sessions). Histopathological (hematoxylin-eosin, orcein, Masson trichrome, and picrosirius red stains) and immunohistochemical assessment for skin biopsy specimens were done before laser resurfacing and after 1 and 6 months. Histometry for epidermal thickness and quantitative assessment for neocollagen formation; collagen I, III, and VII; elastin; and tropoelastin were done for all skin biopsy specimens. Both lasers resulted in increased epidermal thickness. Dermal collagen showed increased neocollagen formation with increased concentration of collagen types I, III, and VII. Dermal elastic tissue studies revealed decreased elastin whereas tropoelastin concentration increased after laser resurfacing. Neither laser showed significant difference between their effects clinically and on dermal collagen. Changes in epidermal thickness, elastin, and tropoelastin were significantly more marked after ablative laser. The small number of patients is a limitation, yet the results show significant improvement. Multiple sessions of fractional laser have comparable effects to a single session of ablative Er:YAG laser on dermal collagen but ablative laser has more effect on elastic tissue and epidermis.

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

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.

A comparative study of skin resurfacing using a fractional Er: YAG laser versus medium-depth peeling in the management of post-acne sequelae Fractional Er:YAG versus medium-depth peeling in post-acne sequel

Background: Post-acne scarring is a common permanent disfigurement to the face and various treatment modalities are available. Chemical peeling and ablative lasers have been used with varying degrees of success and complications. Objective:In this study we compared the effects of medium-depth chemical peel by sequential use of glycolic acid (GA) and trichloroacetic acid (TCA), with a combination treatment of fractional and conventional Er:YAG lasers. Methods: one hundred and twenty patients with post-acne scarring were randomly divided over two equally-sized groups. Group I underwent medium-depth chemical peeling and group II was treated with fractional Er:YAG laser. Patients were evaluated both subjectively and objectively during each follow-up visit. Results: Laser therapy was more effective than medium-depth peel. Subjective evaluation showed a higher satisfaction rate of 87.5% in group IL satisfaction fell to 52.5% in group I. Objective evaluation showed very goodto excellent outcome in 82.5% of cases treated in group II. In group I outcome was good in 47.5% and poor in 32.5% of cases. Conclusion: Combined Er:YAG laser therapy had a shorter downtime, was more effective, showed a longer lasting effect and proved safer than the combined use of GAITCA chemical peels.

The Efficacy and Safety of Ablative Fractional Resurfacing Using a 2,940-Nm Er:YAG Laser for Traumatic Scars in the Early Posttraumatic Period

BackgroundSkin injuries, such as lacerations due to trauma, are relatively common, and patients are very concerned about the resulting scars. Recently, the use of ablative and non-ablative lasers based on the fractional approach has been used to treat scars. In this study, the authors demonstrated the efficacy and safety of ablative fractional resurfacing (AFR) for traumatic scars using a 2,940-nm erbium: yttrium-aluminum-garnet (Er:YAG) laser for traumatic scars after primary repair during the early posttraumatic period.MethodsTwelve patients with fifteen scars were enrolled. All had a history of facial laceration and primary repair by suturing on the day of trauma. Laser therapy was initiated at least 4 weeks after the primary repair. Each patient was treated four times at 1-month intervals with a fractional ablative 2,940-nm Er:YAG laser using the same parameters. Post-treatment evaluations were performed 1 month after the fourth treatment session.ResultsAll 12 patients completed the study. After ablative fractional laser treatment, all treated portions of the scars showed improvements, as demonstrated by the Vancouver Scar Scale and the overall cosmetic scale as evaluated by 10 independent physicians, 10 independent non-physicians, and the patients themselves.ConclusionsThis study shows that ablative fractional Er:YAG laser treatment of scars reduces scars fairly according to both objective results and patient satisfaction rates. The authors suggest that early scar treatment using AFR can be one adjuvant scar management method for improving the quality of life of patients with traumatic scars.

Comparison of the effectiveness of nonablative fractional laser versus ablative fractional laser in thyroidectomy scar prevention: A pilot study

A scar is a mark that remains after the healing of a wound or other morbid processes. In the past, treatment was mainly focused on severe scarring, such as the hypertrophic and burn scars. However, scars from relatively minor wounds can also be stressful. The site of an open thyroidectomy is the anterior neck, a prominently exposed part of the body, where postoperative scarring can cause patients distress. The cosmetic outcome of the scar after thyroidectomy is of particular importance to women, who constitute the majority of patients with thyroid disease. Active prevention is more likely to yield better cosmetic results and would require fewer treatment sessions and less expense than scar revision procedures. Many interventions have been proposed, but there is yet no universal consensus on optimal treatment. Recently, focus has been made on ‘laser scar prevention’, where various types of lasers have been used to improve the appearance of scars. The purpose of this study was to improve the appearance of scars, by laser intervention of the wound healing process. In this pilot study, we comparatively examined the effect of non-ablative 1550-nm fractional Er: glass laser and ablative 2940-nm fractional Er: YAG laser on fresh surgical scars of patients with Fitzpatrick skin type III-IV.