Nonablative Laser Resurfacing Research Articles

Combined use of combined laser therapy and autologous plasma with cells in patients with post-acne atrophic scars

BACKGROUND: The formation of atrophic post-acne scars often leads patients to severe psychological depression and social exclusion. To date, many post-acne treatment options have been described, in particular fractional non-ablative laser resurfacing, exposure to platelet-rich plasma, but there is still no standard line of therapy.
 AIMS: to study the effectiveness of combined therapy with neodymium (Nd:YAG) and erbium (Er:YAG) lasers and autologous platelet-rich plasma in patients with various phenotypes of atrophic post-acne scars.
 MATERIAL AND METHODS: The study involved patients (n=58) over the age of 18 with different types (cleaved, rectangular, navicular) of atrophic post-acne scars, who were divided into 2 groups depending on the method of therapy. Group 1A (n=28) received phototherapy using combined exposure to neodymium (Nd:YAG) and erbium (Er:YAG) lasers; Group 1B patients (n=30) were treated with autologous platelet-rich plasma immediately after laser treatment.
 To assess the effectiveness of therapy, the Manchester scale of scar deformities was used according to five indicators ― color, texture, relief, displacement of surrounding tissues, density (MSS) and the International Global Aesthetic Improvement Scale (GAIS). Indicators of skin elasticity in the foci of atrophy were determined using cutometry; epidermal-dermal structure (thickness, echogenicity) was assessed by ultrasound. The clinical picture was assessed before and after treatment.
 RESULTS: The effectiveness of therapy was confirmed by the dynamics of symptoms on the MSS scale, in particular, an improvement in the "color" indicators by 54.8% in group 1A, by 83.7% in group 1B, "texture" ― by 57.1 and 78.1%, "relief" ― by 43.8 and 66.7%, "displacement" ― by 54.9 and 82.1%, respectively. The proportion of patients with an optimal result according to GAIS in group 1A was 50%, in group 1B ― 90%; with a significant improvement ― 50 and 10%, respectively. Cutometry and ultrasound data also showed better results in the autologous platelet-rich plasma supplemented group.
 CONCLUSION: Thus, complex treatment, including the use of combined laser therapy (erbium and neodymium lasers) and autologous plasma with cells, is a highly effective method for the treatment of atrophic post-acne scars.

Efficacy and Safety of Topical Dexpanthenol-Containing Spray and Cream in the Recovery of the Skin Integrity Compared with Petroleum Jelly after Dermatologic Aesthetic Procedures

Moisturizers are commonly prescribed after laser and chemical peel aesthetic procedures, but the evidence regarding their efficacy and safety of such use is scarce. We conducted four single-blind, three-week, controlled studies to evaluate the efficacy and safety of topical Dexpanthenol-containing products (Bepantol® spray and Bepantol® cream) using petroleum jelly as a positive control. Skin recovery was assessed after four aesthetic procedures: (1) non-ablative facial laser resurfacing, (2) laser depilation on the external genital and inguinal regions, (3) chemical peel on the external genital and inguinal regions, and (4) ablative facial laser resurfacing. Efficacy was assessed through transepidermal water loss (TEWL) combined with clinical assessment of the skin by the investigators and the participants. In studies (1) and (4), the erythema intensity was evaluated by measuring dermal temperature with a thermal imaging camera. Safety was assessed through adverse event reporting and acceptability through a questionnaire. Dexpanthenol-containing products significantly decreased TEWL and dermal temperature, therefore maintaining skin integrity, promoting its recovery, and reducing erythema. No statistical differences with the positive control were observed. In addition, Dexpanthenol-containing products were well appreciated by the participants from a sensory perspective. These findings suggest that these Dexpanthenol-containing products are adequate for post-procedural care in aesthetic dermatology.

Fractional CO2 laser vs. Fraxel laser for lower eyelid rejuvenation following transconjunctival lower blepharoplasty

Aim: Transconjunctival CO2 laser lower blepharoplasty is considered to be a safe and reliable approach. A retrospective review of transconjunctival approached CO2 laser lower blepharoplasty associated with fractional CO2 laser ablation or fractioned non-ablative Fraxel laser resurfacing for lower eyelid rejuvenation is presented for comparison.

Resurfacing of facial acne scars with pulsed carbon dioxide laser: a case series of 10 patients

<p class="abstract">Acne vulgaris is a common skin disorder affecting 80% of people between 11-30 years of age with many experiencing some degree of scarring. Pulsed wave carbon dioxide (CO2) laser resurfacing is a recent addition in armamentarium of treatment options for acne scars. This study focuses on one of the most common type of acne complication - atrophic scars treated with pulsed wave carbon dioxide laser. To evaluate efficacy of pulsed carbon dioxide laser for treatment of mild to moderate atrophic facial acne scars. 10 subjects (6 male and 4 females, aged 22-35 years) with skin type III-V and atrophic acne scars were treated with 4 sessions of carbon dioxide non-ablative laser resurfacing on 6 weeks interval. 7 out of 10 subjects in our study perceived an excellent to good improvement with 2 patients showing fair improvement and 1 patient with no improvement. Adverse effects were limited to prolonged erythema (two patients), and post-inflammatory hyperpigmentation (three patient). Excellent to good clinical improvement observed in 70% of patients with acne scars. This underscore pulsed carbon dioxide laser’s effectiveness in the treatment of mild to moderate atrophic acne scars.</p>

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.

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.

The readability of online patient information about laser resurfacing therapy

Because there are important distinctions between ablative and non-ablative laser resurfacing, accurate and effective patient education is paramount. However, as more patients use the internet as a resource for medical information, little is known about the content and readability of these sources. Thus, we sought to evaluate the readability of major online resources about laser resurfacing while recognizing the recommendations by the American Medical Association and National Institutes of Health. An internet search for the term "Laser Resurfacing" was performed. The first 9 results were identified, patient information from each of these 9 sites were downloaded, and a total of 25 articles were examined. Readability was analyzed using 7 different established tests. Analysis demonstrated an average grade level of at least 9th grade, with all articles exceeding the recommended 6th grade reading level, emphasizing that these resources are too challenging for many patients to read and comprehend. Such materials may hamper appropriate decision-making in patients considering the use of a laser for their dermatologic conditions. The potential detrimental effect on the opinion, participation, and satisfaction of laser resurfacing should spur dermatologists to be more critical of online patient materials and motivated to produce more appropriate resources.

Variable heat shock response model for medical laser procedures

According to the standard Arrhenius relation, tissue damage is linearly dependent on the duration of exposure to elevated temperatures and exponentially dependent on the temperature itself. However, recently published measurements of damage threshold temperatures at extremely short exposure times (commonly present during laser treatments) exhibit a shift to temperatures that are higher than what would normally be expected from a single-process Arrhenius model. A novel variable heat shock (VHS) response model was developed that takes into account the observed deviation from the single-process Arrhenius relation, by assuming that the cell viability can be described as the combined effect of two biochemical processes that dominate cell survival characteristics at very short and very long exposure times. The potential implications of the VHS model are explored theoretically through an example of non-ablative laser resurfacing. The VHS model shows that under the appropriate conditions, very high temperature heat shocks can be generated within the superficial epithelium tissue layer without causing irreversible tissue damage. A mechanism of action for tissue regeneration by means of non-ablative resurfacing with the Er:YAG laser is proposed, which involves indirect triggering of tissue regeneration through intense heat shock to the epithelia, in addition to the tissue regeneration mechanism by means of direct thermal injury to deeper lying connective tissues.

Effects of 1,540-nm Fractional Nonablative Erbium and 2,940-nm Fractional Ablative Erbium on p53 Epidermal Expression After 3 months: A Split-Face Interventional Study.

Expression of p53 by keratinocytes may be important in the pathogenesis of skin cancer induced by ultraviolet light. We used side-by-side nonablative and ablative erbium fractional laser resurfacing to assess the effects on expression of p53 by facial keratinocytes. Ten female patients (age range, 50-63 years) with Fitzpatrick skin Types I-IV and clinical signs of photoaging underwent erbium fractional laser resurfacing (nonablative, 1,540-nm; ablative, 2,940-nm) on opposite sides of the face. Skin biopsies were obtained before treatment and 3 months after treatment for comparison with control biopsies of face and inner arm, quantifying p53 in immunostained tissue sections. Only ablative (2,940-nm) treatments produced a statistically significant reduction in p53 scoring after 3 months. The histologic appearance of skin after ablative resurfacing more closely resembled inner arm skin (rather than facial skin) of control subjects. Epidermal repopulation with p53-negative keratinocytes through ablative erbium fractional laser resurfacing may diminish the risk of eventual malignancy in photoaged skin.

Hybrid Fractional Ablative and Nonablative Laser Resurfacing of Actinic Keratoses

Hybrid Fractional Ablative and Nonablative Laser Resurfacing of Actinic Keratoses

Laser and light-based treatments of acne and acne scarring

The treatment of acne and acne scarring with lasers and light-based and energy-based technologies has become an integral component of our therapeutic arsenal. Lasers including infrared wavelengths and pulsed dye lasers; light devices including blue light, red light, and broadband light; and photodynamic therapy with aminolevulinic acid and methylaminolevulinic acid have been shown to be effective in the treatment of acne vulgaris. The optimal outcomes are achieved with photodynamic therapy combined with medical therapy. Acne scarring has been best treated with lasers, including nonablative infrared lasers, fractional nonablative and ablative laser resurfacing, and most recently needle-based radiofrequency devices.

Nonablative Fractional Laser Resurfacing for Acne Scarring in Patients With Fitzpatrick Skin Phototypes IV-VI.

There is a paucity of studies investigating laser resurfacing in Fitzpatrick skin phototypes (SPT) IV to VI. To assess the efficacy and safety of fractional nonablative laser resurfacing in the treatment of acne scarring in patients with SPT IV to VI. The authors conducted a randomized, investigator-blinded and rater-blinded, split-face comparative study of adults with SPT IV to VI and facial acne scars treated with 2 different density settings and the same fluence. Quantitative global scarring grading system (QGSGS) scores were significantly improved from baseline at 16 and 24 weeks (p = .0277). Improvements in QGSGS scores after higher and lower density treatments were statistically similar (p = .96). The live-blinded dermatologist, the blinded dermatologist photoraters, and the patients rated scars as being significantly more improved by visual analog scale at weeks 16 and 24 compared with baseline (p < .001) for both treatment densities. Five of 7 and 3 of 7 patients in the higher and lower density group, respectively, experienced mild or moderate hyperpigmentation as an investigator observed site reaction. The nonablative 1550-nm fractional laser is safe and efficacious in treating acne scaring in Fitzpatrick skin types IV to VI. Self-limited postinflammatory hyperpigmentation was a common occurrence, especially with higher treatment densities.

Fractional nonablative laser resurfacing: is there a skin tightening effect?

Fractional photothermolysis, an approach to laser skin resurfacing that creates microscopic thermal wounds in skin separated by islands of spared tissue, was developed to overcome the high incidence of adverse events and prolonged healing times associated with full coverage ablative laser procedures. To examine whether fractional nonablative laser resurfacing induces skin tightening. A literature review was performed to evaluate the clinical and histologic effects of fractional nonablative laser resurfacing and full coverage ablative resurfacing procedures. Fractional nonablative lasers produce excellent outcomes with minimal risk and morbidity for a variety of clinical conditions, including photodamaged skin, atrophic scars, surgical and burn scars. Efforts to induce robust fibroplasia in histologic specimens and skin tightening in the clinical setting have yielded inconsistent results. A better understanding of the histology of fractional laser resurfacing will help to optimize clinical outcomes.

What's new in acne? An analysis of systematic reviews published in 2011-2012

This review summarizes important clinical developments in acne vulgaris identified from 17 systematic reviews published between February 2011 and August 2012. Regarding causes, Demodex mites have been shown to be associated with both acne vulgaris and rosacea, although it is unclear if their eradication improves either disease. Some weak evidence has emerged that suggests a possible link between dairy produce and acne, which warrants further research. With reference to the effects of acne, there is good evidence that acne negatively affects quality of life, self-esteem and mood in adolescents. Acne is also associated with an increased risk of anxiety, depression and suicidal ideation, highlighting the importance of asking patients with acne directly about psychological issues in order to identify those who might benefit from early psychiatric support. Regarding treatment, there seems to be no additional benefit to using higher strengths of benzoyl peroxide, and lower strengths such as 2.5% have fewer side effects. Despite earlier concerns of increased mortality in those using topical tretinoin for skin cancer prevention, a systematic review on this topic has not found any convincing evidence of a link between such non-cutaneous events and once-daily application of 0.02-0.05% tretinoin. Combined oral contraceptives are of benefit in both inflammatory and non-inflammatory acne. Current surveys suggest that implementation of the pregnancy prevention programme for isotretinoin may not be stringent, and a high level of monitoring and audit is recommended. Ablative and non-ablative laser resurfacing for the treatment of acne scars may be beneficial, but further studies with a longer follow-up period are required.

Treatment of traumatic scars using fat grafts mixed with platelet-rich plasma, and resurfacing of skin with the 1540 nm nonablative laser

Many treatments have been proposed for cosmetic or functional improvement of scars. It is known that fat grafts and laser treatment can have beneficial effects on remodelling of scar tissue, and platelet-rich plasma (PRP) can be effective during the wound-healing process. We hypothesized that these combined treatments would be effective in improving traumatic scars, with minimal recovery time and few side-effects. The purpose of this study was to compare and evaluate the efficacy of three procedures for the treatment of traumatic scars. We treated 60 patients affected by traumatic scars involving different body parts. All patients were randomly allocated to one of three groups (20 patients per group) and underwent one of three different procedures. Group A was treated with fat grafts mixed with PRP, group B was treated with nonablative laser, and group C was treated with both procedures. Comparison of the groups showed that PRP produced a significant difference in these treatments. The most effective scar treatment was the combination of fat grafts mixed with PRP plus nonablative laser resurfacing (group C). This treatment resulted in group C having an increase of 22% in wound healing compared with group A, and an increase of 11% compared with group B. The data confirm the efficacy of all three treatments, with the most effective scar treatment being the fat grafts mixed with PRP, followed by skin resurfacing with nonablative laser. This combined treatment appeared to be safe and effective for scar treatment. Further studies are needed to explore the potential use of this combined treatment.

Reduction of thickened flap using fractional carbon dioxide laser

The paramedian forehead flap is an excellent choice when repairing a large nasal defect. However, even when carefully thinned, the flap may develop a bulky appearance, an ill-fitting contour, or trap door deformity. When on the face, these suboptimal results can be quite distressing. Surgical and non-surgical options for improvement exist. Surgical options include additional debulking and reorientation of the flap. Non-surgical options include intralesional corticosteroids or 5-flourouracil, dermabrasion, and ablative and non-ablative laser resurfacing. Each option has limited benefit as well potential side effects. Case report. In this report, we present dramatic improvement of a thickened paramedian forehead flap using the Fraxel Re:pair, a fractional carbon dioxide (CO(2) ) laser (Solta Medical, Inc. Hayward, CA). To our knowledge, this is the first case in the literature demonstrating successful reduction of a bulky flap using a fractional ablative laser.

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.

Recent Advances in Combination Treatments for Photoaging: Review of the Literature

Photoaging of the skin is a condition characterized by a combination of physical findings including dyspigmentation, fine wrinkles, telangiectasias, tactile roughness, and precancerous change. A combination approach, treating these changes in skin pigmentation and texture simultaneously, is often required to ensure patient satisfaction. To review the dermatologic literature on the use of combination treatments in photoaging using Medline. Review of the Medline literature identified 24 studies of combination approaches to photoaging in which physician and patient evaluation of efficacy of the treatment approaches were performed. Ten studies contained histologic evidence that combination approaches to photoaging, including nonablative and ablative laser resurfacing, topical retinoids, and topical photosensizers with lasers and light sources, produced cutaneous repair of photodamaged skin. These studies documented histologic improvement in various features of photodamaged skin, including change in epidermal and dermal thickness and stratum corneum compaction, greater type I and III collagen production, and less sunburn cell and thymine dimer formation after ultraviolet light exposure. Review of the literature demonstrates the progress of dermatologic science in understanding the cellular and molecular mechanisms of ultraviolet light-induced damage and in the development of novel combination approaches for repair of photodamage and prevention of cutaneous malignancy.

Pharmacotherapy of actinic keratosis

Actinic keratosis (AK) represents the initial intraepidermal manifestation of abnormal keratinocyte proliferation with the potential of progression to squamous cell carcinoma (SCC). When in limited numbers, clinically visible AKs are treated individually with ablative and/or surgical procedures (lesion-directed treatment), while multiple and sublinical AKs are treated with field-directed therapies that use ablative, nonablating and other topically applied treatment modalities. Owing to difficulties in predicting which AK will progress to SCC, the general rule is to treat all AKs. The goals of treatment are to eliminate the AKs, minimizing their risk of progression to invasive SCC, while pursuing good cosmetic outcomes. Prevention is the most important treatment modality for AKs. Avoidance of sun and artificial sources of ultraviolet light, applying sunscreen and self-examination are among the most effective preventive measures. Chemopreventive modalities such as retinoids, 2-(Difluoromethyl)-dl-ornithine (DFMO), perillyl alcohol, T4 endonuclease V, and dl-α-tocopherol are described. Lesion-directed treatment modalities include cryotherapy, surgery and electrodessication with or without curettage. Field-directed treatment modalities include nonablative and ablative laser resurfacing, dermabrasion, chemical peels, topical immunomodulators (imiquimod, 5-fluorouracil and diclofenac) and photodynamic therapy. And, finally, newer and investigational treatment modalities such as ingenol mebutate, resiquimod and betulinic acid are also being discussed.

Clinical Trial of Dual Treatment with an Ablative Fractional Laser and a Nonablative Laser for the Treatment of Acne Scars in Asian Patients

Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that has been proposed. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced. To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers. A series of 20 patients (skin phototypes IV-V) with atrophic facial acne scars were randomly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high (group A) and low (group B) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half. Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively. Clinical assessment scores were determined at each treatment session and follow-up visit. Although the use of the ablative fractional laser with high energy resulted in an improvement in patients' acne scars, the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results, as assessed in photographs as well as by the overall appearance of the acne scars. With the combination method, fewer complications were observed.