Laser Skin Resurfacing Research Articles

Facial Acne Scarring

Facial Acne Scarring

Laser Treatment of Dark Skin

The growing diversification of the patient population coupled with the increasing demand for cosmetic laser rejuvenation has highlighted the need to develop cutaneous laser systems and establish treatment protocols for patients with a wide range of skin conditions and phototypes. Recent technologic advancements have provided viable treatment options to achieve clinical outcomes that were previously only attainable in patients with lighter skin tones. This review provides an updated discussion of the range of laser treatments available for pigmented skin and sets the stage for further advancements. Pigment-specific laser technology with green, red, or near-infrared light targets a variety of pigmented lesions such as lentigines, ephelides, café-au-lait macules, and melanocytic nevi as well as tattoos and unwanted hair. Short-pulsed alexandrite, ruby, and neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers are used for pigmented lesions and tattoos, whereas their longer pulse-width laser counterparts are used for laser-assisted hair removal. Vascular lesions and hypertrophic scars can be treated with a variety of vascular-specific lasers, but it is the pulsed dye laser (PDL) that has long been the gold standard treatment for these lesions due to its high specificity for hemoglobin and its ability to improve skin surface texture in children and adults. Laser skin resurfacing techniques for photodamaged skin and atrophic scars have been optimized with fractional technology to produce excellent clinical outcomes and minimal complication risks. Radiofrequency and nonablative lasers are also used to provide skin tightening and collagen remodeling with virtually no postoperative recovery.

Outcomes of Fractional CO2 Laser Application in Aesthetic Surgery: A Retrospective Review

Despite the effectiveness of ablative CO(2) laser resurfacing for facial rejuvenation, its application has been limited owing to an undesirable side-effect profile, including prolonged hyperemia and potential pigmentary changes. However, newer fractional CO(2) laser technology has reduced the recovery time and led to decreases in postprocedural hypo- and hyperpigmentation. The authors investigate the application and outcomes of ablative fractional technology in a private cosmetic surgery practice. In this retrospective cohort study, the charts of patients who received fractional CO(2) laser resurfacing between March 2007 and May 2008 were reviewed. Data regarding patient demographics, pretreatment regimens, detailed operative data, and posttreatment findings were obtained. The length of hyperemia (less than five weeks, five to eight weeks, and more than eight weeks), complication rates, and revision rates were analyzed. A satisfaction survey was also sent to all patients. Throughout the 19-month study period, 97 patients received 101 treatments with an average follow-up of 4.5 months. Full-face laser resurfacing was performed in 81.1% of patients, with 64.3% receiving their treatment under local anesthesia without sedation. Length of hyperemia was less than five weeks in 93%, five to eight weeks in 5.9%, and more than eight weeks in 0.9% of patients. Hyperpigmentation (9.9%), milia (6.9%), acne breakout (5.9%), and transient ectropion (0.9%) were less common. Patient satisfaction surveys revealed that a majority of patients were satisfied with their results. New fractional CO(2) laser skin resurfacing is associated with shorter periods of hyperemia, resulting in shorter recovery time in comparison with older ablative technology. The side-effect profile is minor and infrequent. This new technology provides significant clinical improvement with high patient satisfaction.

Cosmetic Surgery Survey of American Society of Oculoplastic and Reconstructive Surgery Members and a 6-Year Comparison

To examine the current cosmetic practices of American Society of Oculoplastic and Reconstructive Surgery members using a survey and compare those results with a similar survey that was performed 6 years prior, and to determine the types and breadth of cosmetic procedures that are currently performed within the field of ophthalmic plastic and reconstructive surgery. A 49-question survey was sent to members of American Society of Oculoplastic and Reconstructive Surgery by post mail and/or electronic mail in 2007. The questions covered surgeon demographics, cosmetic practice design, and preferences for aesthetic procedures and commercial equipment and products. Frequencies and percentages of responses were obtained for each question individually. Responses to similar questions in a 2001 survey were compared with those in the current survey. Two hundred fifty-seven members of 488 responded (53%). Eighty-two percent of respondents (208 of 253) performed some type of cosmetic procedure. Fifty-five percent of respondents reported that less than 25% of their practice consisted of cosmetic procedures and services. Thirty-one percent of respondents reported that 25% to 75% of their practice was cosmetic. A slightly higher percentage of respondents reported that more of their practice consisted of cosmetic procedures and services compared with 6 years ago; however, the difference did not reach statistical significance (p = 0.895). A lower percentage of respondents injected Botox cosmetic (p = 0.02), offered ablative laser skin resurfacing (p < 0.001), and performed rhytidectomy (p < 0.001) in 2007 compared with 2001.

Fractionated Laser Skin Resurfacing Treatment Complications: A Review

Fractional photothermolysis represents a new modality of laser skin resurfacing that was developed to provide a successful clinical response while minimizing postoperative recovery and limiting treatment complications. To review all of the reported complications that develop as a result of fractional ablative and nonablative laser skin resurfacing. A literature review was based on a MEDLINE search (1998-2009) for English-language articles related to laser treatment complications and fractional skin resurfacing. Articles presenting the highest level of evidence and the most recent reports were preferentially selected. Complications with fractional laser skin resurfacing represent a full spectrum of severity and can be longlasting. In general, a greater likelihood of developing post-treatment complications is seen in sensitive cutaneous areas and in patients with intrinsically darker skin phototypes or predisposing medical risk factors. Although the overall rate of complications associated with fractional laser skin resurfacing is much lower than with traditional ablative techniques, recent reports suggest that serious complications can develop. An appreciation of all of the complications associated with fractional laser skin resurfacing is important, especially given that many of them can be potentially prevented. The authors have indicated no significant interest with commercial supporters.

Wound healing after laser skin resurfacing: The effect of a silver sulfadiazine-hyaluronic acid-containing cream under an occlusive dressing

Introduction: Occlusive dressings promote wound healing after laser skin resurfacing. Our goal was to evaluate whether a cream containing hyaluronic acid–silver sulfadiazine could improve this process. Methods: Ten guinea pigs received laser resurfacing on the skin of their backs. Polyurethane foam film adhesive dressing was applied. A cream containing hyaluronic acid–silver sulfadiazine was applied under the dressing over half of the wound. Skin biopsies were taken at days 2, 4, 7 and 9 and examined by a pathologist blinded to the study. Results: Re-epithelialization appeared to occur faster in the cream-treated areas, together with a lower level of acute inflammation in the early phase of the healing process. Conclusions: The cream containing silver sulfadiazine/hyaluronic acid seems to improve wound healing after laser skin resurfacing in guinea pigs. The clinical application of this finding on humans should be assessed.

Improvement of Postfractional Laser Erythema with Light-Emitting Diode Photomodulation

The most common side effects of fractional laser skin treatment are erythema and edema. Low-level light therapy and light-emitting diode (LED) devices have been used to stimulate fibroblast activity and hasten wound healing. To determine whether LED treatment immediately after fractional laser skin resurfacing affects the severity and duration of postoperative eythema. Twenty patients received treatment with a 590-nm wavelength LED array to randomly selected facial halves immediately after undergoing full-face fractional laser skin resurfacing with a 1,550-nm erbium-doped fiber laser. Differences in erythema between LED-treated and untreated facial halves were recorded at 24, 48, and 96 hours post-treatment. The LED-treated facial halves were less erythematous in all 20 patients 24 hours postoperatively. The six patients who received the highest mean energy densities during fractional laser treatment continued to exhibit decreased erythema in the LED-treated areas at 48 hours. At 96 hours post-treatment, no discernible differences between facial halves were observed in any patient. Photomodulation with a 590-nm-wavelength LED array can decrease the intensity and duration of postfractional laser treatment erythema.

Carbon Dioxide Laser Resurfacing

Carbon Dioxide Laser Resurfacing

Fractional Carbon Dioxide Laser and Plasmakinetic Skin Resurfacing

Photodamage is one of the most common reasons that patients visit a dermatologist's office. Carbon dioxide (CO(2)) laser resurfacing has always been the gold standard for reversing photodamage. Because of the relatively high incidence of side effects and the prolonged downtime associated with CO(2) resurfacing, new technologies have emerged to address photodamage. Portrait skin regeneration (PSR) is a novel device that has been developed to treat photodamage, and this device yields fewer side effects and downtime than traditional CO(2) laser resurfacing. At our center, we have performed more than 500 high-energy PSR treatments and have developed a unique and highly effective treatment protocol. In addition, fractional CO(2) laser resurfacing has emerged as the latest technology developed to combat photoaging. This technology yields impressive results and is much safer and causes less downtime than traditional CO(2) laser resurfacing. In this article, we will review our treatment techniques and protocols as well as address patient selection, preoperative and postoperative care, and anesthesia.

Fraxel Laser Indications and Long-Term Follow-Up

Fractional photothermolysis, based on creating spatially precise microscopic thermal wounds, is performed using a 1550-nm erbium fiber laser that targets water-containing tissue to effect the photocoagulation of narrow, sharply defined columns of skin known as microscopic thermal zones. According to the authors, Fraxel resurfacing has been shown to be both safe and effective for facial and nonfacial photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation. Because only a fraction of the skin is treated during a single session, a series (typically 3 to 6 treatments) of fractional resurfacing at 2- to 4-week intervals is required for the best clinical improvement. It is the authors' experience that a series of Fraxel treatments can achieve a similar clinical result for atrophic scars compared with traditional ablative laser skin resurfacing. However, the improvement seen after a series of Fraxel treatments for perioral laxity and rhytides often falls short of the impressive results that can be achieved with ablative laser skin resurfacing.

Keratoacanthoma with perineural invasion: An indicator for aggressive behavior?

Neurotropic invasion of keratoacanthoma (KA) is rare and can easily be missed histologically. A 36-year-old woman developed a KA on the upper lip four weeks after CO(2) laser skin resurfacing; it showed microscopic evidence of perineural invasion. Despite repeated treatment with intralesional methotrexate, the KA recurred after 6 months. She was then treated with ionizing radiation (56 Gy) and has been tumor-free for more than 3 years. Immunohistochemistry showed decreased expression of desmoglein 1 as it is seen in squamous cell carcinomas. In most cases not much importance is attached to perineural invasion which is frequently seen in KA because of the high rate of spontaneous regression. Our case suggests that perineural invasion may be an indicator for aggressive growth of head-and-neck KAs so that histologically-controlled excision is recommended.

To Debride or Not to Debride? That Is the Question

BACKGROUND The treatment standard for laser skin resurfacing (LSR) includes aggressively wiping away the char with moist gauze before and after each pass to prevent heat buildup and lateral tissue damage from existing char. No published study has addressed not debriding between passes with traditional higher fluence, high-density, multipass CO2 LSR in humans. PURPOSE The objective was to disprove the dogma that wiping away the laser char between treatment passes is necessary. MATERIALS AND METHODS A total of 158 patients were treated over a 23-month period with multipass, nondebrided CO2 laser resurfacing (6 J/cm2, density 6). A small series of split-face studies were performed by debriding one side and not debriding the other side after each pass, and 89 full-face patients were treated without debriding any char between two or three passes. Histologic and photographic studies were performed in selected patients to determine the differences between debrided and nondebrided techniques. RESULTS None of the nondebrided patients experienced significant complications. Operative times were shortened as was postlaser pain and erythema. CONCLUSION Histologic analysis showed that three passes of 6 J/cm2 with a density of 6 produces extremely similar epidermal and dermal changes regardless of debriding between passes or not. This is the first study in humans using high-energy, high-density, multipass LSR without debriding between passes.

To Debride or Not to Debride? That Is the Question: Rethinking Char Removal in Ablative CO2Laser Skin Resurfacing

The treatment standard for laser skin resurfacing (LSR) includes aggressively wiping away the char with moist gauze before and after each pass to prevent heat buildup and lateral tissue damage from existing char. No published study has addressed not debriding between passes with traditional higher fluence, high-density, multipass CO(2) LSR in humans. The objective was to disprove the dogma that wiping away the laser char between treatment passes is necessary. A total of 158 patients were treated over a 23-month period with multipass, nondebrided CO(2) laser resurfacing (6 J/cm(2), density 6). A small series of split-face studies were performed by debriding one side and not debriding the other side after each pass, and 89 full-face patients were treated without debriding any char between two or three passes. Histologic and photographic studies were performed in selected patients to determine the differences between debrided and nondebrided techniques. None of the nondebrided patients experienced significant complications. Operative times were shortened as was postlaser pain and erythema. Histologic analysis showed that three passes of 6 J/cm(2) with a density of 6 produces extremely similar epidermal and dermal changes regardless of debriding between passes or not. This is the first study in humans using high-energy, high-density, multipass LSR without debriding between passes. The authors have indicated no significant interest with commercial supporters.

Laser-Assisted Blepharoplasty and Inferior Lateral Retinaculum Plication: Skin Contraction Versus Skin Traction

Blepharoplasty is one of the most commonly performed operations in plastic surgery, especially among middle-aged patients. Ablative lasers, especially the carbon dioxide laser, assist in tissue cutting and hemostasis. These lasers also offer skin resurfacing with its unique advantages despite the prolonged downtime. The authors present their laser-assisted blepharoplasty experience and the recent addition of one simply performed, inferior lateral retinaculum plication to the procedure (single suture traction technique, SSTT). Hence, the need for laser skin resurfacing of the lower eyelid has been reduced due to the skin traction applied, avoiding the long period required for resolution of erythema and potential hyperpigmentation. Furthermore, the tightening effect on the canthal ligament offers a more youthful look to the surgically treated eye.

Periocular Er:YAG laser skin resurfacing in ablative, dual mode and smooth mode – a histological comparison

Abstract Purpose: The aim of the study is to histologically compare Er:YAG laser skin resurfacing using ablative, dual‐mode and smooth mode parameters. Methods: 30 patients with blepharochalasis were treated with a 2940 nm Er:YAG laser (Fidelis by Fotona) at day 0, 7 and 21 before elective blepharoplasty. At time of surgery the irradiated lid tissue has been removed and prepared for histological analysis. The laser settings used in the ablative mode were: fluence 2.5 – 4.5 J/cm2, spot size 5 mm, repetition rate 5 – 8 Hz, pulse length 300 μs; dual mode: first pass as in ablative mode, then second pass with fluence 0.5 – 1.5 J/cm2, spot size 5mm, repetition rate 12 – 15 Hz, pulse length 300 μs and 60% overlapping; smooth mode: fluence 0.75 – 2.00 J/cm2, spot size 5 mm, repetition rate 20 Hz, pulse length 550 μs, no overlapping. Results: We observed deep collagen denaturation at fluences above 1.25 J/cm2 and total epidermal damage at fluences above 1.75 J/cm2; complete regeneration of epidermis at day 7 and collagen remodeling up to 240 μm deep at day 21 after smooth mode laser treatment. These changes were statistically significantly different compared to changes after ablative and dual‐mode treatment. Conclusions: Smooth mode Er:YAG laser skin resurfacing is a safe and effective method producing new collagen synthesis and remodeling, with less epidermal damage compared to ablative and dual‐mode resurfacing.

Ablative laser resurfacing: high-energy pulsed carbon dioxide and erbium:yttrium-aluminum-garnet

The development of the short-pulsed high-energy carbon dioxide laser in the mid 1990's led to the emergence of laser skin resurfacing. Used in the continuous mode, the CO 2 laser can cut and coagulate simultaneously. Used in the pulsed mode, the CO 2 laser is a powerful tool for epidermal ablation in many different contexts both therapeutic and cosmetic. Both the CO 2 and Erbium YAG lasers emit light in the infrared spectrum. Energy is preferentially absorbed by intracellular water creating rapid heating and vaporization of tissue. Because of the wavelength of the Er:YAG laser (2940nm) more closely approximates the absorption peak of water (3000nm) the target chromophore than the CO 2 laser (10,600nm) nearly all of the energy is absorbed in the epidermis and papillary dermis yielding superficial ablation and less underlying thermal damage. The advantages, disadvantages, and applications of each type of laser resurfacing will be discussed. Despite proven efficacy, the public acceptance of laser resurfacing has declined with the emergence of new laser systems that cause dermal remodeling without ablating the overlying epidermis dramatically reducing recovery time. In the absence of blinded comparison studies, it remains unclear whether the clinical results of the newer ‘nonablative' laser systems compare with their ablative predecessors.

Proof of new collagen synthesis in lid skin after Er:YAG laser skin resurfacing with in‐situ hybridization

Abstract Purpose: The aim of the study is to prove new collagen synthesis in lid skin fibroblasts and correlate it to laser energy fluence after Er:YAG laser skin resurfacing, using the method of in situ hybridization. Methods: Lid skin of 9 patients with blepharochalasis was treated with laser at day 7 and 21 before elective blepharoplasty, when it was excised for further investigation. We used a 2940 nm Er:YAG laser (Fidelis by Fotona) with smooth mode parameters: laser fluence 0.75 – 2.00 J/cm2, spot size 5 mm, repetition rate 20 Hz, pulse length 550 μs, 6 pulses per packet, packet length 250 ms, no overlapping. We designed 2 oligonucleotide RNA probes for pro‐alpha 1 and pro‐alpha 2 collagen and labeled them with radioactive Sulphur 35. At time of surgery the excised tissue was frozen in dry ice. Tissue sections were incubated with the probes and marked with film emulsion for 10 days. We counted silver grains over specific cells, which were identified with imunohistochemistry. Results: We noticed significant elevation of pro‐alpha‐collagen mRNA expression in the laser treated areas of lid skin compared to untreated areas. Pro‐alpha‐collagen mRNA expression was particularly dense in cells, identified as fibroblasts by imunohistochemistry. Pro‐alpha‐collagen mRNA expression in these cells correlated with laser fluence used in treatment of lid skin. Conclusions: The method of in situ hybridization brings a definitive proof of new collagen synthesis in skin fibroblasts after Er:YAG laser skin resurfacing; and it is possible to measure the rate of new collagen synthesis as a function of the applied laser fluence.

Analysis of Erythema after Er:YAG Laser Skin Resurfacing

Postoperative erythema can be expected to occur in every patient after laser resurfacing, and pigmentary disturbances may be related to the intensity and the duration of erythema. This study was undertaken to assess the clinical features of erythema, the factors that influence its duration, and the relation between the duration of erythema and the incidence of hyperpigmentation and hypopigmentation in skin of Asian persons after Er:YAG laser resurfacing. A total of 218 patients (skin phototypes III to V) were recruited and treated with a short-pulsed Er:YAG laser, a variable-pulsed Er:YAG laser, or a dual-mode Er:YAG laser for skin resurfacing. Clinical assessments were performed retrospectively using medical charts and serial photographs. Postoperative erythema was observed in all patients after Er:YAG laser resurfacing with a mean duration of 4.72 months. In 98.2% of patients, erythema faded completely within 12 months. Postinflammatory hyperpigmentation was observed in 38.1% of patients after Er:YAG laser resurfacing. Skin phototype, level of ablation, and depth of thermal damage caused by a long-pulsed laser appear to be important factors that affect the duration of erythema. Moreover, prolonged erythema was related to the risk of postinflammatory hyperpigmentation.

Laser-Faltenbehandlung

Prolonged exposure to UV-radiation induces a variety of visible skin changes such as lentigines, actinic keratoses and solar elastosis. Laser skin resurfacing using ablative lasers (CO(2) or Erbium:YAG) is a popular procedure to reduce these marks and improve the aesthetic appearance of photoaged facial skin. Skin resurfacing is defined as an ablation of the upper layers of facial skin. Possible side effects are hyperpigmentation, hypopigmentation and, at worst, scarring. The"down time" after the skin resurfacing procedure is about 7 to 10 days. This is the major drawback of resurfacing and the main reason why subsurfacing/skin rejuvenation is becoming even more popular. The literature is not clear on whether this newer approach is as effective as resurfacing.

Comparison of the open technique with a new wound dressing, H2460, in the healing of an acute wound after laser skin resurfacing

Background: Applying various dressings or leaving the treated area open are two techniques in use after laser skin resurfacing (LSR). Objective: This study was conducted to compare healing of an acute wound using a new hydrocolloid dressing, H2460, with the open technique. Methods: Immediately after LSR, one side was covered with the new hydrocolloid dressing H2460 and the other side was left open. Participants were instructed to clean the open side four times a day and replace the H2460 dressing if it was dislodged. Results: In the volunteers' and investigator's evaluations, the new dressing H2460 generally outperformed the ‘open’ technique. At the 1‐month follow‐up, eight of 10 volunteers reported that the H2460 side resulted in better healing; two of 10 volunteers felt there was no difference between the two sides for final outcome and none believed that the open side had better healing. Overall, the H2460 side healed better in the majority of participants as graded by the blinded observer (60%) and participant themselves (80%). Conclusion: The new hydrocolloid dressing H2460 is a better and suitable alternative to the open technique to manage an acute wound after LSR.