Nonablative Fractional Photothermolysis Research Articles

A systematic review of treatments for acne scarring. Part 2: Energy-based techniques.

Introduction:Acne scarring is a very common problem, which can be extensive, and may lead to significant psychosocial morbidity. Multiple types of treatments are used to ameliorate atrophic scars with varying degrees of success. This paper provides an overview of the various energy-based modalities that are commonly employed against acne scarring.Objectives and methods:A comprehensive literature search of papers published since 2008 was performed in order to determine the efficacy and adverse reactions of commonly used energy-based treatments against post-acne scarring.Results:A total of 59 relevant articles were identified covering a multitude of different devices.Discussion:Ablative lasers seem to achieve the highest degree of efficacy, albeit this is associated with significant pain and downtime, and the risk for long-term pigmentary changes. Non-ablative fractional photothermolysis (FP) has a much safer profile but cannot achieve as good cosmetic results. The efficacies of fractional radiofrequency microneedling and radiofrequency are slightly inferior to that of FP but offer an even safer adverse profile. Little evidence is available on the remaining devices, with larger studies required in order to reach more solid conclusions.Conclusion:Multiple devices have been used with varying levels of efficacy and very different safety profiles. There is an overall lack of high-quality evidence about the effects of different interventions. Furthermore, no standardised scale is available for acne scarring, leading to variability in evaluation and interpretation of data in different studies.

Randomized placebo-controlled trial comparing efficacy of nonablative fractional photothermolysis combined with topical calcipotriol for the treatment of keloid and hypertrophic scar

Randomized placebo-controlled trial comparing efficacy of nonablative fractional photothermolysis combined with topical calcipotriol for the treatment of keloid and hypertrophic scar

Novel use of non-ablative fractional photothermolysis for café-au-lait macules in darker skin types.

The removal of café-au-lait macules (CALMs) in patients with darker skin phototypes poses a significant challenge due to limited available therapeutic options and increased risk of adverse effects, including permanent scarring and further dyspigmentation. Herein, we demonstrate the novel use of non-ablative fractional photothermolysis for the safe removal of CALMs in individuals with Fitzpatrick skin type (FST) IV-V. Retrospective analysis of four patients (FST IV-V) with CALMs revealed that three of these patients had greater than 50% clearance after multiple treatment sessions with the non-ablative fractional 1,550-nm erbium-doped fiber laser. This report demonstrates the utility and safety of non-ablative fractional resurfacing in the treatment of CALMs in darker skin phototypes. Lasers Surg. Med. 49:84-87, 2017. © 2016 Wiley Periodicals, Inc.

Combination of non-ablative fractional photothermolysis and 0.1% tacrolimus ointment is efficacious for treating idiopathic guttate hypomelanosis

Background: The efficacy of fractional photothermolysis and topical use of calcineurin inhibitors as treatments of idiopathic guttate hypomelanosis (IGH) have been reported. Data on combination treatments are lacking. Objectives: To evaluate the efficacy and safety of 1550-nm ytterbium/erbium fiber laser combined with 0.1% tacrolimus ointment as a treatment of IGH.Methods: In each patient with IGH, two lesions were assigned as a treatment group, whilst two lesions on another side were chosen as control. Four treatments by fractional 1550-nm ytterbium/erbium fiber laser were delivered every four weeks combined with a twice daily topical application of 0.1% tacrolimus ointment. Lesional skin color was measured by colorimeter. Digital and dermoscopic digital photographs were taken and evaluated by three dermatologists. Results: A total of 120 lesions were treated. Combination treatment normalized the relative lightness index of IGH which reached statistical significant compared with the control at week 12, after three sessions of laser treatment (p = 0.026). Physicians’ assessment score revealed that 91.67% of the lesions on treatment side showed an improvement. Swelling and redness were the most common side effects which spontaneously resolved. Conclusion: Fractional 1550-nm ytterbium/erbium fiber laser combined with topical 0.1% tacrolimus ointment was effective for IGH.

The role of laser and intense pulsed light in the treatment of hyperpigmentation disorders

Objective This article reviews the treatment of hyperpigmentation disorders with laser and intense pulsed light (IPL). Data sources Previous literatures, reviews, and studies as well as medical websites (PubMed, MD consult, Medscape) and scientific journals databases were searched from the start date of each database. Study selection Selection was done by supervisors for studying new advancements in treating hyperpigmented lesions with laser and IPL devices. Data extraction In this review data from published studies were manually extracted and summarized. Study quality assessment included determining whether ethical approval was obtained, prospective design, eligibility criteria specified, appropriate controls used, adequate follow-up and defined outcome measures achieved. Data synthesis In this review several studies of the role of laser and IPL in treating hyperpigmented lesions were included. There are different laser and IPL devices for treating hyperpigmented lesions with different indications. We got our data from studying the different types of laser and IPL approaches to know which one is preferred taking into consideration different complications of the approaches. Findings A total of 44 studies were included in the review as they were deemed eligible by fulfilling the inclusion criteria. Of these 44 articles, included in this review, 32 were laser studies and 12 were IPL studies. Studies indicate that laser and IPL therapy can be effective in the treatment of a wide variety of hyperpigmented skin lesions using the basic principles of selective photothermolysis. A full understanding of laser and IPL principles and the characteristics of the lesion to be treated is essential for the effective and safe use of light-based therapies. Conclusion Progress in laser and IPL technology has involved the development of safer and more efficient methods of achieving the desired effects on hyperpigmented skin lesions. The Q-switched lasers with their high peak power and pulse width in the nanosecond range are best suited to treat various epidermal, dermal, and mixed lesions. Long-pulsed ruby and alexandrite lasers have been shown to be effective in the treatment of Q-switched ruby laser-resistant congenital nevi and other pigmented lesions. Nonablative fractional photothermolysis holds great promise in treatment of both pigmentary variation as well as skin textural abnormalities. Intense pulsed technology is a highly versatile, safe, and effective modality for the treatment of pigmented lesions.

Non-ablative fractional photothermolysis in treatment of idiopathic guttate hypomelanosis.

Idiopathic guttate hypomelanosis (IGH) is a common pigmentary disorder affecting a large number of individuals. Many patients seek medical attention due to aesthetic concern. However, no standard treatment is available. To evaluate the efficacy and side-effects of non-ablative fractional photothermolysis (FP) as a treatment of IGH. A total of 120 lesions from 30 patients with IGH were treated. In each patient, two lesions on the extremities were assigned to treatment group, while lesions from the other side served as control. The treatment was delivered by fractional 1550-nm ytterbium/erbium fibre laser for four times at 4-week intervals. Lesional skin colour was measured by colourimetry. Digital photographs and dermoscopic digital photographs were taken at weeks 0, 4, 8, 12 and 16. In addition, patient satisfaction score and side-effects were recorded. All clinical photographs were evaluated by three experienced dermatologists to determine clinical improvement using a quartile grading scale. Colourimetry of the treatment side showed normalization of skin colour at each visit and was statistically significant when compared with control after two treatments (week 8) and continued to decrease until 4weeks' follow-up (week 16) (P=0.047, 0.016 and 0.06 respectively). Physicians' improvement grading score showed that 83.34% of the lesions in treatment group vs. 18.34% in the control group showed some improvement. The difference was statistically significant (P<0.05). Common side-effects were erythema and oedema in treatment area, which were mild and transient. No post-inflammatory hyperpigmentation was observed. Non-ablative FP appears to be an effective way to treat IGH. The improvements are documented by both objective and subjective measurements.

Laser fractional photothermolysis of the skin: Numerical simulation of microthermal zones

Background: Laser Fractional Photothermolysis (FP) is one of the innovative techniques for skin remodeling and resurfacing. During treatment, the control of the Microscopic Thermal Zones’ (MTZs) dimensions versus pulse energy requires detailed knowledge of the various parameters governing the heat transfer process. In this study, a mathematical model is devised to simulate the effect of pulse energy variations on the dimensions of MTZs. Methods: Two series of simulations for ablative (10.6 μm CO2) and non-ablative (1.550 μm Er:Glass) lasers systems were performed. In each series, simulations were carried for the following pulses energies: 5, 10, 15, 20, 25, 30, 35, and 40 mJ. Results of simulations are validated by histological analysis images of MTZs sections reported in works by Hantash et al. and Bedi et al. Results: MTZs dimensions were compared between histology and those achieved using our simulation model using fusion data technique for both ablative FP and non-ablative FP treatment methods. Depths and widths from simulations are usually deeper (21 ± 2%) and wider (12 ± 2%) when compared with histological analysis data. Conclusion: When accounting for the shrinkage effect of excision of cutaneous tissues, a good correlation can be established between the simulation and the histological analysis results.

Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers

Background: Nonablative fractional photothermolysis has been reported to show early promise in the treatment of hypertrophic scars, but there are few reports on ablative fractional photothermolysis for the treatment of hypertrophic scars. Aim: To evaluate and compare the efficacy and safety of Er:YAG fractional laser (EYFL) and CO2 fractional laser (CO2FL) for treatment of hypertrophic scars. Methods: Thirteen patients with hypertrophic scars were treated with 2,940 nm EYFL, and ten were treated with 10,600 nm CO2FL. An independent physician evaluator assessed the treatment outcomes using Vancouver scar scale (VSS) and 5-point grading scale (grade 0, no improvement; grade 1, 1–25%; grade 2, 26–50%; grade 3, 51–75%; grade 4, 76–100% improvement). Patients are queried about their subjective satisfaction with the treatment outcomes. Results: After the final treatment, average percentage changes of VSS were 28.2% for EYFL and 49.8% for CO2FL. Improvement was evident in terms of pliability, while insignificant in terms of vascularity and pigmentation. Based on physician's global assessment, mean grade of 1.8 for EYFL and 2.7 for CO2FL was achieved. Patient's subjective satisfaction scores paralleled the physician's objective evaluation.Conclusion: CO2FL is a potentially effective and safe modality for the treatment of hypertrophic scars, particularly in terms of pliability.

Ablative Fractional Versus Nonablative Fractional Lasers—Where Are We and How Do We Compare Differing Products?

The concept of nonablative fractional photothermolysis was introduced almost a decade ago to address the main shortcomings of non-fractionated, nonablative devices available at that time. By delivering laser light as a series of fractionated columns, the 1550 nm Er:doped laser was able to achieve greater penetration depths and spare areas of normal intervening skin, allowing epidermal contribution to a more rapid healing process. Yet these devices, despite their more predictable outcomes, were felt to lack the efficacy of complete epidermal ablation, spawning the expansion of fractionated devices to include ablative wavelengths, which have proven more consistent and safer than pre-existing pulsed ablative devices. This article will summarize an ever-expanding literature to facilitate the application of both nonablative and ablative fractional technologies in clinical practice, and establishes grounds by which varying fractional lasers can be compared.

Adverse events of nonablative fractional laser photothermolysis: A retrospective study of 856 treatments in 362 patients

Adverse events of nonablative fractional laser photothermolysis: A retrospective study of 856 treatments in 362 patients

Ulceration of Mature Surgical Scars Following Nonablative Fractional Photothermolysis Associated with Intralesional Lidocaine Injections

Ulceration of Mature Surgical Scars Following Nonablative Fractional Photothermolysis Associated with Intralesional Lidocaine Injections

Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy

Fractional photothermolysis has been shown to improve various types of scarring, including atrophic acne scars. The aim of the present authors was to assess the efficacy and safety of the nonablative fractional photothermolysis in the treatment of moderate and severe acne scars. Eighty-seven patients with moderate or severe acne scarring were treated with six sessions with a 1540-nm Erbium glass fiber laser at 3-week intervals. Six months after the final session, 7/87 (8%) patients showed a moderate improvement, whereas 80/87 (92%) patients had a marked improvement. In a subset of patients, the present authors also applied in vivo reflectance confocal microscopy to highlight the relevant microscopic changes. Hence, early and late posttreatment findings, most importantly the replacement of a coarser collagen with a new one, similar to the collagen seen in healthy skin, were observed. In accordance to previous studies, the present authors conclude that nonablative fractional photothermolysis is a safe and effective treatment for moderate or severe acne scarring.

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Fractional laser resurfacing for acne scars: a review

This review investigates the effectiveness of ablative and nonablative fractional photothermolysis (FP) lasers for treating facial acne scars. Twenty-six studies (13 ablative FP, 13 nonablative FP) published between 2003 and January 2011 were reviewed. Quantitative and qualitative data from each article were examined and analysed. Four studies were split-face randomized controlled studies. While the data analysed were all clinically relevant and significant, there were some methodological differences between the studies. Outcomes included subjective and objective assessment of scar appearance, pre- and postoperative treatment, side-effects and pain scores. A small number of studies used three-dimensional optical imaging profiling and histology for objective assessment. Even allowing for methodological variability, ablative FP had an improvement range of 26-83% whereas nonablative FP had an improvement range of 26-50%. Patients who underwent treatment with an ablative FP laser experienced erythema for 3-14 days which resolved by 12 weeks, whereas patients who opted for the nonablative FP laser experienced erythema for between 1 and 3 days and this resolved within a week. A higher proportion of patients (up to 92·3%) who underwent ablative FP experienced postinflammatory hyperpigmentation (PIH) than those who had nonablative FP (up to 13%). The maximum duration of PIH in ablative FP was up to 6 months whereas in nonablative FP it lasted for up to 1 week. The procedure with ablative FP was relatively uncomfortable compared with nonablative FP. The pain score with ablative FP ranged from 5·90 to 8·10 (scale 1-10) and with nonablative FP from 3·90 to 5·66 (scale 1-10).

Treatment of actinic keratoses and photodamage with non-contact fractional 1540-nm laser quasi-ablation: an ex vivo and clinical evaluation

The main use of non-ablative fractional photothermolysis today is for the improvement of wrinkles and scars. The purpose of this work was to evaluate the effect of a "classic" non-ablative fractional 1540 nm on facial photodamaged skin and actinic keratoses. Seventeen patients with facial actinic keratoses (AKs) and photodamage underwent two or three laser treatments with fractional 1540-nm erbium glass laser at fluences of 75 mJ, 15 ms pulse duration, and 10-mm spot size in non-contact mode. Two blinded assessors and participants evaluated clinical improvement of treatment areas after 3 months, using a quartile grading scale (no improvement = 0, 1-25% improvement = 1, 26-50% = 2, 51-75% = 3, and 76-100% = 4). Three months after the last treatment, the mean level of improvement was 3.4 ± 0.72 for AK and 3.3 ± 0.54 for skin appearance. Adverse events observed after each treatment were moderate erythema, mild edema, erosions (two cases), and mild desquamation. No scarring or post-inflammatory pigmentary changes were observed. The clinical results were supported by histological changes observed in Yucatan pig studies in vivo and ex vivo. The 1540-nm fractional erbium glass laser in the non-contact mode is a safe and effective treatment for facial photodamage and AKs.

Combination of fractional erbium-glass laser and topical therapy in melasma resistant to triple-combination cream

Background: Melasma is a common melanosis often difficult to treat. Objective: The aim of this paper was to report on the safety and efficacy of non-ablative fractional photothermolysis combined with the use of triple-combination cream (TCC) on a large population with melasma resistant (i.e., with no complete/near-complete clearing) to TCC alone. Methods: Seventy-six patients with resistant melasma underwent a combined treatment protocol. The protocol consisted of a TCC (hydroquinone 4%, retinoic acid 0.03%, hydrocortisone butyrate 0.1%) applied daily for 10 days followed by four laser treatments performed in 3-week intervals with a fractional 1540-nm erbium-glass laser. During these intervals, and for 3 months after the last laser session, TCC was also applied daily following a "pulse-therapy" scheme. Improvement was assessed by the melasma-area-and-severity-index (MASI) score. Results: At 1 month, marked (>75%) and moderate (51–75%) clearing of melasma were observed in 46 of 76 (67.1%) and 12 of 76 (21%) cases, respectively. At 6 months, we noticed a marked improvement in 16 of 76 (21.1%) and no improvement in 33 of 76 (43.4%) patients. Conclusion: Our study proposes the combination of NFP/TCC as a useful therapy for patients with melasma resistant to TCC alone, but it shows that its long-term efficacy is limited.

A systematic review of laser resurfacing for acne scars

A systematic review of laser resurfacing for acne scars

The 1540-nm Nonablative Fractional Photothermolysis for Facial Surgical Scars

Introduction: Nonablative fractionated photothermolysis creates microscopic zones of thermal damage extending down into the dermis. The epidermis is left intact, allowing for rapid healing with minimal downtime for the patient. The deep heating of the dermis can help with rejuvenation of the skin by promoting neocollagenesis. The purpose of this study is to evaluate the effectiveness of 1540-nm nonablative fractional photothermolysis for facial surgical scars. Materials and Methods: Four patients with varying Fitzpatrick skin types had facial surgical scars treated with a 1540-nm nonablative fractionated photothermolysis. Results: All patients showed marked improvement in the appearance of their scars with no adverse pigmentary changes. The 1540-nm nonablative fractional resurfacing laser should be considered a first-line treatment for postsurgical scarring. Conclusions: Nonablative fractional photothermolysis with a 1540-nm wavelength is an excellent method to improve the appearance of facial surgical scars. It can be done with a minimum amount of downtime and should be safe for all skin types.

Herpes Zoster in the Distribution of the Trigeminal Nerve After Nonablative Fractional Photothermolysis of the Face: Report of 3 Cases

Herpes Zoster in the Distribution of the Trigeminal Nerve After Nonablative Fractional Photothermolysis of the Face: Report of 3 Cases

Acute Effects of Fractional Laser on Photo-Aged Skin

Nonablative fractional photothermolysis (FP) laser treatment has shown clinical efficacy on photo-aged skin. Few studies have examined the molecular responses to FP. To characterize the dynamic alterations involved in dermal matrix remodeling after FP laser treatment. A single multipass FP treatment was performed. Baseline, day 1, and day 7 biopsies were obtained. Biopsies were sectioned and stained for histology and immunofluorescence confocal microscopic. Heat shock protein-70 (HSP-70) and matrix metalloproteinase-1 (MMP-1) expression and extracellular matrix (ECM) autofluorescence were examined. Quantitative real-time polymerase chain reaction (qRT-PCR) experiments were performed probing for collagen 1A1 (COL1A1) and COL3A1. All three patients were Caucasian women aged 49, 62, and 64 with Fitzpatrick skin types II, III, and IV. Transient neutrophilic infiltration found on day 1. Protein expression of HSP-70 and MMP-1 were up-regulated on day 1, reverting to baseline by day 7. ECM autofluorescence decreased from baseline to day 7. qRT-PCR showed a minor decrease in COL1A1 and COL3A1 messenger RNA 1day after treatment. Variable results between patients receiving equal treatment were evident.