Laser Resurfacing Techniques Research Articles

Apparatus methods in complex treatment of patients with atrophic scars

Atrophic scars are a common pathology that can have a negative impact on the patient’s quality of life. Methods for correcting atrophic scars include chemical peels, dermabrasion, ablative or non-ablative laser resurfacing, filler insertion, and surgical techniques. Depending on the type and severity of the scar, an individual approach is required to obtain satisfactory results. Material and methods. The study included 32 patients with atrophic scars. Depending on the therapy, the patients were divided into two groups in which they received microneedle radiofrequency therapy or fractional photothermolysis. The effectiveness of the methods of therapy was assessed using laser doppler fluometry and ultrasound scanning. Research results. The RF microneedle method and fractional photothermolysis have a positive effect on the epidermal-dermal structure of the skin, which is expressed in the approximation of the acoustic density and thickness of the epidermis and dermis to normal values, and also improve microcirculation. When analyzing the results of correction of atrophic scars, more pronounced positive dynamics was observed after the application of RF microneedles.

SKIN MICRONEEDLING PLUS SPOT TRICHLOROACETIC ACID PEEL IN THE TREATMENT OF ATROPHIC POST ACNE SCARS: COMPARATIVE SPLIT FACE STUDY

Background: Post Acne scarring is an unfortunate and frequent complication of acne vulgaris that results in many psychological and emotional problems for patients and the families. Acne scarring may be either atrophic or hypertrophic. Atrophic acne scars are further subdivided morphologically into boxcar, icepick, or rolling scars. Objective: To compare between the effect of microneedling using dermapen and microneedling plus medium depth chemical peeling using T.C.A 30% in post acne atrophic scars. Patients and methods: This study was carried out on 30 patients with different clinical variants of atrophic post acne scars diagnosed clinically on the basis of typical appearance of skin lesions. Patients were recruited from Dermatology Department outpatient clinic in Al-Azhar University hospitals from April 2019 to December 2019. Their ages ranged from 18: 30 years. Assessment of scars in both sides of face was done for their type, number, depth (severity) before and after each session and when the follow up period became completed (2 weeks after the last session). Digital Facial photographs for right and left sides of the face were obtained before treatment, during each session, and when the follow up period became completed (2 weeks after the last session). Results: Most of the patients (60%) achieved marked improvement, 30% achieved good improvement and 10% achieved excellent improvement on the left side of the face, while on the right side of the face most of patients (73.3%) achieved good response and 26.7 % achieved poor response. The mean percentage of improvement of the left side was 55.5 %, while the percentage of improvement of the right side was 33%. Conclusion: Automated microneedling (Dermapen) and T.C.A 30% chemical peel were minimally invasive simple, cheap and effective techniques in the treatment of post acne atrophic scars and improved skin homogeneity and texture. Microneedling plus spot T.C.A 30% have the advantage of rapid healing, short down time, eliminating most of risks and negative side-effects of laser resurfacing or cross technique. The treatment can be performed in an office setting and did not need any extensive special training or expensive instruments and can be used for rejuvenation of the skin, remodeling of the scar. Combination of automated microneedling with other modalities as spot T.C.A 30% for the treatment of post acne atrophic scars gave better results than the use of single modality of treatment as microneedling alone.

Innovative methods in treatment of patients with atrophic post-acne scars

Atrophic scars after acne are a widespread condition that can have a negative impact on the patient’s quality of life. Correction methods for acne scars include chemical peeling, dermabrasion, ablative or non-ablative laser resurfacing, filler insertion and surgical techniques. Depending on the type and severity of the scar, an individual approach is required to obtain satisfactory results.Material and methods. Under observation were 61 patients with various manifestations of post-acne. Among them 21 (34.44 %) men and 40 (65.57 %) women. Depending on the therapy, the patients were divided into two groups and two subgroups depending on the type of scar. Efficiency was evaluated using ultrasound scanning.Results. The RF microneedle method and fractional photothermolysis have a positive effect on the epidermo-dermal structure of the skin, which is expressed in the approximation of the acoustic density and thickness of the epidermis and dermis to normal values. The most pronounced positive effect in both methods was noted in the correction of post-acne hypertrophic scars. When analyzing the results of correction of atrophic scars, more pronounced positive dynamics was observed after the use of RF microneedles.

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.

Laser resurfacing of Al–Zn–Mg–Si coatings

The feasibility of refinement of Al–Zn–Mg–Si hot dip coatings by diode laser resurfacing has been demonstrated. The microstructure of the laser resurfaced coatings was characterised mainly by transmission electron microscopy and also by scanning electron microscopy. The variance of heat input results in different cooling rates and varying degrees of refinement; that is, the higher the power density, the lower the cooling rate and the larger the secondary dendrite arm spacing of α-Al dendrites. In addition, the inherent variation of chemical composition in coatings also affects the microstructure as well as phase distribution. This laser resurfacing technique has not only reduced the secondary dendrite arm spacing/α-Al dendrites but also changed the solidification path and produce different phases and microstructure in the interdendritic areas.

Hair transplant for acne scars: an innovative approach

Postacne scarring is a common entity that affects patients both physically and psychologically. Treatment of facial scarring is rarely a mono-dimensional process. Various modalities of treatments from cheaper subcision, punch techniques and excision to expensive laser resurfacing techniques are available. Treatment of postacne scars in a particular case has to be individualized, taking into consideration many factors like age, gender, types of scarring, Fitzpatrick skin type, and socioeconomic status of the patient. In this article, we describe an innovative method of simply doing hair transplantation in acne scars and hence making them less visible and cosmetically well acceptable to the patient.

Treatment of Acne Scars in Asian Patients Using a 2,790-nm Fractional Yttrium Scandium Gallium Garnet Laser

Treatment of atrophic scars using a fractional laser resurfacing technique has demonstrated favorable outcomes. To evaluate the efficacy and safety of 2,790-nm-wavelength ablative fractional resurfacing on atrophic acne scars in Asian individuals. Twenty participants (8 female, 12 male, mean age 26) with skin phototype IV and atrophic acne scars were treated with two sessions of 2,790-nm ablative fractional resurfacing laser at a 6-week interval. Objective and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and 1 and 3 months after the final treatment. At the 3-month follow-up, 70% of the participants were rated as having at least 50% to 89% improvement of scars. Mild erythema was the most common adverse effect, observed in 30% of participants, but resolved completely in an average of 5 days. Yttrium scandium gallium garnet ablative fractional resurfacing (2,790-nm) appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians. The authors have indicated no significant interest with commercial supporters.

Multimodal Management of Atrophic Acne Scarring in the Aging Face

Atrophic facial acne scarring is a widely prevalent condition that can have a negative impact on a patient’s quality of life. The appearance of these scars is often worsened by the normal effects of aging. A number of options are available for the treatment of acne scarring, including chemical peeling, dermabrasion, ablative or nonablative laser resurfacing, dermal fillers, and surgical techniques such as subcision or punch excision. Depending on the type and extent of scarring, a multimodal approach is generally necessary to provide satisfactory results. Resurfacing techniques correct surface irregularities, long-lasting dermal fillers address the volume loss resulting from acne, and sub-superficial musculoaponeurotic system (SMAS) face-lift procedures counter the soft tissue laxity and ptosis associated with aging. This article briefly reviews the evolution of individual approaches to treating atrophic acne scarring, followed by case examples illustrating results that can be achieved using a multimodal approach. Representative cases from patients in their 30s, 40s, and 50s are presented. In the author’s clinical practice, multimodal approaches incorporating fractionated laser, injectable poly-l-lactic acid, and sub-SMAS face-lift procedures have achieved optimal aesthetic outcomes, high patient satisfaction, and durability of aesthetic effect over time.

Retrospective analysis of non‐ablative scar treatment in dark skin types using the sub‐millisecond Nd:YAG 1,064 nm Laser

The use of lasers to treat atrophic scarring conditions in darker skin types presents a significant challenge to laser practitioners. Current treatment modalities, including deep dermal peels; ablative; non-ablative; and fractional laser resurfacing and surgical techniques, are limited in skin types IV through VI due to increased risks of hyper- and hypo-pigmentation. This is especially true when attempting to treat large areas of acne scarring. This study investigates the treatment of atrophic scarring with a non-ablative sub-millisecond-pulsed 1,064 nm Nd:YAG laser in darker skin types. To evaluate the safety and efficacy of a sub-millisecond 1,064 nm Nd:YAG laser for the treatment of atrophic scarring in Fitzpatrick skin types III-VI through retrospective photographic analysis. A retrospective analysis was conducted of all patients (n = 22) who received sub-millisecond Nd:YAG laser treatments for atrophic scarring over a 6-month period. Patients had Fitzpatrick skin types III-VI and were treated for the indication of atrophic scarring using the fluence of 14-16 J/cm(2) , pulse duration of 300-500 microseconds and repetition rate of 5-7 Hz. An average of six treatments was performed on each patient approximately 3 weeks apart and the mean follow-up time after the final treatment was 9 months (range of 3-10 months). Blinded photographic assessments were performed by three independent physicians using photos unlabeled for before and after and arranged in non-chronological order. Reviewers were asked to determine before and after photos and the degree of improvement in scarring, textural change, and post-inflammatory hyper-pigmentation (PIH) secondary to the acne or scarring condition. Degree of improvement was graded using a four-point scale: 0 = <25%, 1 = 25-50%, 2 = 51-75%, 3 = 76-100%. Based on blinded photo assessments by three independent reviewers, clinically and statistically significant median improvement of 2 in scarring, 2.3 in texture, and 2 in pigment were observed (one-sample Wilcoxon signed rank test, P < 0.001). Reviewers were highly consistent (inter-reviewer reliability) in identification of before and after photos (kappa of 0.88). Preliminary data collected in this retrospective study suggest that sub-millisecond 1,064 nm Nd:YAG laser treatment is a safe and effective treatment for atrophic scarring in patients with darker skin types, delivering clinically and statistically significant results with reduced risk of pigment complications and patient discomfort.

Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians

Treatment of atrophic scars with a fractional laser resurfacing technique has demonstrated favorable outcomes, although data on the efficacy and adverse effects of this procedure in persons with dark-skinned phototypes are limited. This study was conducted to evaluate the efficacy and safety of carbon-dioxide ablative fractional resurfacing on atrophic acne scars in Asian individuals. Thirteen subjects (8 female and 5 male, aged 25-52 years) with skin phototype IV and atrophic acne scars were treated with 3 sessions of carbon-dioxide ablative fractional resurfacing laser on an average of 7-week interval. Objective (ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment. At the 6-month follow-up, 85% of the subjects were rated as having at least 25% to 50% improvement of scars. Improvement significantly progressed from the 1-month follow-up to the 6-month follow-up (P = .002). At 1 month after 3 treatments, surface smoothness (P = .03) and scar volume (P < .001) significantly improved, compared with baseline measurements. Of the subjects, 62% rated themselves as having at least 50% improvement in their scars. Mild postinflammatory hyperpigmentation was the most common adverse effect observed in 92% of the subjects or 51% of treatment sessions, and was completely resolved in an average of 5 weeks. The small sample size was a study limitation. Carbon-dioxide ablative fractional resurfacing appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians.

Emerging Technologies in Aesthetic Medicine

Recent advances in technology have drastically improved aesthetic treatment for skin. Of particular interest is the emergence of laser- and lightbased technologies, which have offered great promise among skin-rejuvenation therapies. New laser resurfacing techniques for skin rejuvenation offer significant advantages over conventional ablative lasers, such as the CO(2) and erbiumYAG laser systems. Nonablative and fractional lasers, although not as efficacious as ablative therapies, are associated with significantly diminished complication rates and shortened recovery times. Novel devices combining ablative and fractional technologies have also surfaced, demonstrating noteworthy results. In this review, the authors will discuss the implications of current developments in research and technology for skin rejuvenation. Furthermore, the authors will address emerging therapies for acne vulgaris, lipolysis, and cellulite.

064-4 Plastie de la paupière inférieure associée à une excision cutanée : la technique du pincement revisitée

Aim The aim of this study is to evaluate the safety, effectiveness and aesthetic results of transconjunctival lower eyelid blepharoplasty associated with skin excision using the Pinch Technique. Materials and Methods 58 patients (45 female and 13 male) aged between 32 and 76 showing the following were selected: prominent eyelid fat pads, anterior lamella laxity and normal eyelid tone; all expressed a desire not to change the shape of their eyes. In all patients the position of the lower eyelid in respect to the limbus in the primary position, in up and low gaze, was evaluated. Lower transconjuctival eyelid blepharoplasty associated with skin excision was performed on all patients using the technique described by Rosenfeld. Results In all patients a satisfactory reduction of fat pads and an improvement in skin laxity were achieved; results met patients’ expectations. There were no cases of eyelid retraction either imediately postoperatively or in later follow-ups. Discussion Transconjunctival lower eyelid blepharoplasty has gained in popularity among opthalmoplastic surgeons over the past decade principally because it results in natural appearance and the absence of eyelid retraction. This technique was initially combined with chemical peeling and later with laser resurfacing techniques to achieve an improvement in the skin. These techniques, however, led to complications such as persistent erithema and hyperpigmentation. In our experience, the technique, recently described by Rosenfeld, of associating transconjunctival blepharoplasty with skin excision, makes it possible to correct eyelid fat pads and reshape skin effectively and without complications since it leaves the middle lamella untouched.

Moist Exposed Therapy

BACKGROUND Laser resurfacing has now become an accepted and important component of facial rejuvenation. With the introduction of computerized scanning systems, the actual laser resurfacing technique has been greatly simplified; however, the final outcome still depends to a large extent on the efficiency of the postlaser wound care in promoting wound healing and preventing early and late complications. It has been repeatedly confirmed that a moist environment is the single most important external factor affecting the rate of re-epithelialization. Occlusive moisture-retentive dressings, however, are difficult to apply and maintain in position and may as well be complicated by serious infections. OBJECTIVE Moist exposed burn ointment has been shown to maintain adequate moisture for optimal healing by frequent ointment application without the need for a secondary overlying dressing. It would be ideal for postoperative laser care. METHODS Twenty-eight consecutive patients treated with coherent ultrapulse CO2 laser in Toulouse, France, were included in the trial. Moisture-retentive ointment was applied over the treated areas every 4 to 6 hours. Healing was assessed clinically and with repeated transepidermal water loss measurements. Swab cultures were taken, and pain was evaluated with a visual analog scale. Colorimetric analysis of pictures taken was statistically compared with picture analysis of 20 patients treated earlier with an occlusive dressing. RESULTS Uneventful timely healing occurred in all patients with minimal pain and discomfort. Healing with moist exposed therapy resulted in faster recovery of cutaneous erythema, as evidenced by colorometry. CONCLUSION Moist exposed burn ointment application can be safely considered a good and valid alternative to occlusive dressings for postoperative laser care.

Moist exposed therapy: an effective and valid alternative to occlusive dressings for postlaser resurfacing wound care.

Laser resurfacing has now become an accepted and important component of facial rejuvenation. With the introduction of computerized scanning systems, the actual laser resurfacing technique has been greatly simplified; however, the final outcome still depends to a large extent on the efficiency of the postlaser wound care in promoting wound healing and preventing early and late complications. It has been repeatedly confirmed that a moist environment is the single most important external factor affecting the rate of re-epithelialization. Occlusive moisture-retentive dressings, however, are difficult to apply and maintain in position and may as well be complicated by serious infections. Moist exposed burn ointment has been shown to maintain adequate moisture for optimal healing by frequent ointment application without the need for a secondary overlying dressing. It would be ideal for postoperative laser care. Twenty-eight consecutive patients treated with coherent ultrapulse CO2 laser in Toulouse, France, were included in the trial. Moisture-retentive ointment was applied over the treated areas every 4 to 6 hours. Healing was assessed clinically and with repeated transepidermal water loss measurements. Swab cultures were taken, and pain was evaluated with a visual analog scale. Colorimetric analysis of pictures taken was statistically compared with picture analysis of 20 patients treated earlier with an occlusive dressing. Uneventful timely healing occurred in all patients with minimal pain and discomfort. Healing with moist exposed therapy resulted in faster recovery of cutaneous erythema, as evidenced by colorometry. Moist exposed burn ointment application can be safely considered a good and valid alternative to occlusive dressings for postoperative laser care.

The Effects of Autologous Platelet Gel on Wound Healing

Laser resurfacing techniques have become a popular means of achieving rejuvenation of damaged skin. Interest is great in attempting to speed re-epithelialization and healing so that patients can return to their normal activities as quickly as possible. Previous studies have demonstrated that wounds heal more quickly when they are covered and kept moist than when they are left open to the air. Until now, no study has been conducted to investigate whether the healing process of a superficial skin burn might be accelerated by the use of an autologous platelet gel as a biologic dressing. Our study of five pigs showed that autologous platelet gel can influence wound healing by stimulating an intense inflammatory process that leads to highly significant increases in the production of extracellular matrices and granulation tissue. The platelet gel accelerated vascular ingrowth, increased fibroblastic proliferation, and accelerated collagen production. However, the gel did not appear to accelerate re-epithelialization. The aggressive production of granulation tissue and the acceleration of collagen production might mean that autologous platelet gel will have a future role in the treatment of burns because the highly vascularized bed it helps create should promote the success of skin grafting in patients with deep partial-thickness and full-thickness burns.

Lower Eyelid Blepharoplasty: Analysis of Indications and the Treatment of 100 Patients

Traditionally, lower lid blepharoplasty has been confined to a choice of skin or skin-muscle flap transcutaneous blepharoplasty. In the past decade, in particular, various new techniques and technologies have emerged, altering our ability to treat the lower eyelids. These techniques include transconjunctival blepharoplasty, a variety of canthopexy procedures, fat-conserving or fat-replacing methods, wedge excision, and laser resurfacing techniques, and they allow a more individualized approach based on variations in anatomical features and patient goals. A retrospective review of data for 100 consecutive patients (ranging in age from 30 to 80 years) who underwent lower eyelid procedures during a 12-month period is presented. Procedures were categorized as follows: lower lid blepharoplasty, 35 cases; lower lid transconjunctival blepharoplasty, 27 cases; lower lid transconjunctival blepharoplasty with laser resurfacing, 17 cases; lower lid laser resurfacing, 16 cases; tarsorrhaphy with lower lid operation, three cases; tarsorrhaphy with laser resurfacing, two cases. Two complications of retained fat pads (one medial and one lateral) were encountered and were addressed with a secondary operation using a transconjunctival blepharoplasty approach. The results indicate that laser treatment has become the predominant form of lower eyelid resurfacing and that transconjunctival blepharoplasty is now the most common surgical procedure for the lower eyelid. All of our tarsorrhaphy procedures were performed for patients who had previously undergone surgical treatment of the lower eyelids. An algorithm based on physical findings and these techniques has been developed, for appropriate tailoring of the procedure to each patient's specific concerns. With the availability of a variety of techniques, an individualized approach based on variations in anatomical features is feasible.

Einsatz des Erbium:YAG-Lasers in der korrektiven Dermatologie

Laser resurfacing techniques are widely used among the spectrum of dermatosurgical procedures in order to remove circumscribed skin lesion as well as larger areas. In particular, Erbium:YAG-laser-technology enables us to perform a highly precise skin ablative work. In a variety of indications superficial skin ablation is safe, not associated with major discomfort, and easy to control. Therefore, this technique has replaced mechanical dermabrasion and other modalities of tissue removal in many indications. Careful laser ablation is of special worth in aesthetic skin surgery, also when treating disorders appearing in atrophic skin of elderly patients or in more delicate areas in order to prevent prolonged healing along with unwarranted side effects.

CO 2 laser vaporization for disfiguring lupus pernio

Presented in this paper are two cases of longstanding gross and disfiguring lupus pernio of the nose successfully treated by CO 2 laser resurfacing techniques. Both patients were resistant to previous medical therapy and have had an excellent postoperative cosmetic result.

Laser resurfacing for facial acne scars.

Most people have acne at some stage during their life, with about one per cent being left with permanent acne scars. Recent laser techniques are thought to be more effective than chemical peels and dermabrasion. To assess the effects of laser resurfacing for treating facial acne scars. We searched MEDLINE (1966 to April 1999), EMBASE (1980 to April 1999), Science Citation Index (1981 to April 1999), the Cochrane Controlled Trials Register (April 1999), DARE (April 1999), INAHTA (April 1999), NHS HTA Internet site (April 1999). Dermatological Surgery (1995 to March 1999) and the British Journal of Dermatology (1995 to September 1999) were handsearched. We searched the reference lists of relevant articles and contacted experts and commercial laser manufacturers. Randomised controlled trials which compare different laser resurfacing techniques for treating patients with facial acne scars, or compare laser resurfacing with other resurfacing techniques or no treatment. Two reviewers independently selected studies, assessed the quality of studies and extracted data. No randomised controlled trials where laser treatment was compared to either placebo or a different type of laser were found. Most of the 27 studies uncovered were poor quality case series with small numbers of acne-scarred patients. The lack of good quality evidence does not enable any conclusions to be drawn about the effectiveness of lasers for treating atrophic or ice-pick acne scars. Well designed randomised controlled comparisons of carbon dioxide versus Erbium:YAG laser are urgently needed.

Laser resurfacing of the neck: a review of 48 cases.

With the advent of the new sophisticated carbondioxide (CO2) laser, effective treatment of facial rhytides and pigmented lesions of the photodamaged skin has been gaining popularity. Partial and full facial skin resurfacings have been reported. However, resurfacing of the neck has been ignored or discouraged. The objective of this study is to assess the feasibility, benefits, and risks of laser resurfacing of the neck, combined with the additional resurfacing of the whole face. A total of 48 patients underwent the procedure with a high-power and short-exposure time CO2 laser (ultrapulse). Patients were evaluated and classified preoperatively. The great majority of patients had local anesthesia (topical and infiltrative) with minimal sedation. A computer pattern generator was used in all cases but one. In this paper, preoperative preparation, postoperative care, laser resurfacing techniques, and depth guidelines are discussed. Incorporating the neck with the facial resurfacing has given very satisfactory results, with minimal drawbacks.