Carbon Dioxide Laser Treatment Research Articles

Fractionated Laser for Vaginal Atrophy Symptoms: A Randomized, Double-Blind Placebo Controlled Study

Study Objective To investigate fractionated carbon dioxide (CO2) laser treatment in treatment post-menopausal vaginal atrophy symptoms. Design A randomized, double-blind, placebo controlled trial. Setting A university-affiliated tertiary care hospital. Patients or Participants Participants were postmenopausal women experiencing vulvovaginal symptoms who were contraindicated to or had an ineffective trial of topical hormonal and non-hormonal vaginal therapy. Interventions Participants underwent 3 treatments, each 4-8 weeks apart of either fractionated micro-ablative CO2 laser treatment at recommended or placebo settings. Both groups had an identical clinical experience. Third party telephone randomization and separate assessment and treatment teams maintained blinding. We assessed the Vaginal Health Index (VHI), collected paired pre- and post-treatment vaginal histopathology and cytology, evaluated self-reported symptom severity by visual analogue scale (VAS) of most bothersome symptom, and impact on livelihood, quality of life and sexual function from baseline to post-treatment as an indicator of treatment efficacy. Measurements and Main Results 232 women were pre-screened, 90 consented, 85 randomized, 83 completed 6-month follow-up and 78 completed 12-month follow-up. Mean age was 57 (range: 30-77). There was no significant difference in severity of the VAS score of the most bothersome symptom between placebo and intervention groups post-treatment (VAS scores: 57.4, 49.4; p=0.22). There was a significant reduction in mean from baseline to 6-months in both the placebo group (21.0; p Conclusion This first placebo-controlled RCT reports no statistically significant differences in any parameter between placebo and intervention groups using fractionated CO2 laser for postmenopausal vaginal atrophy symptoms. Based on our findings, clinical use of this technology cannot be recommended for this indication.

Patient reported vaginal laxity, sexual function and stress incontinence improvement following vaginal rejuvenation with fractional carbon dioxide laser

In this study, we have evaluated the efficiency of fractional carbon dioxide laser in the treatment of vaginal laxity and urinary incontinence. Thirty patients with vaginal laxity, sexual dysfunction and urinary incontinence complaints were treated with fractional carbon dioxide laser. Results were evaluated with patient questionnaires relating to comfort during the procedure and general satisfaction following the procedure. In the survey regarding comfort during the procedure, 90% (n:27) of the patients reported that they were comfortable during the procedure. The survey on the level of general satisfaction six months following the procedure revealed high-moderate level of satisfaction in 86% (n:26) of the patients. 66% (n:20) of the patients reported improved vaginal tightness and 63% (n:19) of the patients reported improvement in the quality of their sexual activity. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12) scores six months following the procedure were not significantly different when compared to the scores prior to the procedure. The average of Questionnaire for Urinary Incontinence Diagnosis(QUID) score prior to the procedure and six months following the procedure was 7.5 and 0.9 respectively (p < 0.05). Fractional carbon dioxide laser treatment results in high level of satisfaction and improvement in vaginal laxity, sexual dysfunction and urinary incontinence symptoms in patients with genitourinary syndrome.

At-Home Transvaginal Device Following Fractional Carbon Dioxide Laser Treatment for Genitourinary Syndrome of Menopause.

Device-based therapeutic approaches have been developed to treat women&rsquo;s genitourinary post-menopausal symptoms. Fractional carbon dioxide laser resurfacing (FxCO2) has been demonstrated to be safe and effective in the treatment of GSM symptoms, however the results begin to wane by 12-months post-treatment. This study aims at assessing the application of an at-home transvaginal red and infrared light device as a maintenance treatment commencing 12 months following FxCO2 laser treatment for genitourinary syndrome of menopause (GSM). Subjects completing 12-month follow-up after three fractional CO2 laser vulvovaginal treatments received an at-home device and monitored for GSM symptoms with long-term follow-up to 12 months (2 years post-laser). 10 post-menopausal subjects completing 12-months follow-up after three FxCO2 vulvovaginal treatments for GSM were treated with an at-home red and infrared LED device. Treatment consisted of intravaginal application three times per week, and subjects were followed to 1, 3, 6, and 12 months. Subjects completed the vaginal assessment scale subject satisfaction, and QUID to assess for vulvovaginal and stress urinary incontinence (SUI) symptoms. Vulvovaginal symptoms measured by VAS were mean 89% improved at 12-month follow-up after FxCO2 and maintained at 73% improved over baseline (2 years post-laser) following an additional 12 months of at-home transvaginal light therapy (P&lt;0.05). VAS symptoms gradually increased over the 12 months maintenance period by a mean of 17% (P&lt;0.05). Mean subject satisfaction was 0 at baseline, 1.86 at 1 year following FxCO2, and 1.00 after an additional 1 year of at-home light therapy. SUI symptoms as measured by QUID were mean 81% improved at 12-month follow-up after FxCO2and maintained at 38% improved over baseline (2 years post-laser) following an additional 12-months of at-home light therapy (P&lt;0.05). SUI symptoms gradually increased by a mean of 43% over the 12-month maintenance period (P&lt;0.05). At-home transvaginal red and near infrared light therapy commencing at 12 months post-FxCO2 vulvovaginal treatment in a post-menopausal population maintained statistically significant improvements in vulvovaginal and SUI symptoms over the additional12-month period (2 years post-laser); however, a gradual return of symptoms suggests that laser re-treatment or combination withhormone therapy may be necessary to maintain optimal outcomes.J Drugs Dermatol. 2020;19(11):1076-1079. doi:10.36849/JDD.2020.1012.

Fractionated Ablative Carbon Dioxide Laser Therapy Decreases Ultrasound Thickness of Hypertrophic Burn Scar: A Prospective Process Improvement Initiative.

Carbon dioxide (CO2) laser treatment is routinely used to treat hypertrophic burn scars (HBS). Although prior research has documented subjective improvement in HBS after treatment, there is little data evaluating objective changes in scar characteristics after therapy. The aim of our process improvement project was to evaluate changes to scar thickness (ST) using high-frequency ultrasound in patients with HBS undergoing CO2 laser therapy. Ultrasound measurements of ST were obtained from patients with HBS before initial and at each subsequent treatment. ST, reduction in ST per treatment, and percentage reduction in ST from baseline were tabulated. Post hoc analyses examining the effect of initial ST and scar maturity on outcome were performed. First, patients were grouped by baseline ST into thicker (group 1, initial ST ≥ median value) and thinner (group 2, initial ST < median value) scar groups. Second, patients were divided into quartiles based on time from injury to treatment. Outcomes at each time point were compared with either Mann-Whitney U or Kruskal-Wallis tests, with Bonferonni corrections performed for post hoc subgroup analyses. Significance was set at P < 0.05. Twenty-one consecutive patients with HBS treated with CO2 laser were included. All patients completed 1 or more treatment, 48% completed 2 or more treatments, and 28% completed 3 treatments. Median initial ST was 0.71 cm (0.44-0.98 cm), and median scar maturity was 7.5 months (4.9-9.8 months). Overall, ST decreased over the treatment course (P < 0.001), with post hoc analysis demonstrating that 2 treatments were required to achieve a significant ST reduction (P < 0.01). On subgroup analysis comparing initial ST, ST decreased significantly in group 1 (thicker scars) overall (P < 0.001) but not in group 2 (P = 0.109). ST reduction was greatest after 1 treatment in group 1 (P = 0.022) and group 2 (P = 0.061). Percent reduction was greater in group 1 relative to group 2 after 1 treatment (P = 0.016). On subgroup analysis of scar maturity, there were no significant differences in either baseline ST or ST at any subsequent visit. Fractionated ablative CO2 laser treatment improved ST after 1 to 2 treatments. Patients with thicker scars demonstrated greater ST reduction than those with thinner scars. Ultrasound adequately assessed treatment response.

Hypertrophic Scar Improvement by Early Intervention With Ablative Fractional Carbon Dioxide Laser Treatment.

Ablative fractional laser treatment has been used to improve the color and texture of hypertrophic scars with safe and effective results. However, no consensus on the optimal time to initiate fractional laser treatment is available. The effect on early-stage scars remains controversial. This study was designed to assess the efficacy and safety of ablative fractional carbon dioxide (CO2 ) laser treatments for hypertrophic burn scars and to analyze the efficacy and safety in the early period within 3 months after injury. We performed a retrospective study of 221 hypertrophic scar patients. According to the time of the first laser treatment after injury, patients were divided into five subgroups, including less than 1 month, 1-3 months, 3-6 months, 6-12 months, and more than 12 months postinjury. One month after the last laser treatment, the scars were assessed by photography, the Vancouver Scar Scale (VSS), durometry, and spectrocolorimetry. The patients included 118 males and 103 females. The average age was 33.6 years. Fire/flame was the primary injury source. Thirty-six percent of the patients underwent at least one fractional CO2 laser treatment. All the included patients, including those treated within 1 month after injury, had significantly decreased VSS scores after laser treatment. We also noted that hardness and redness scores were decreased after treatment for both scars treated within 3 months and those treated more than 12 months after injury. Seepage (17.6%), bleeding (22.2%), and swelling (9.0%) were the main adverse events after laser treatment. This study demonstrated the safety and efficacy of ablative fractional CO2 laser treatment applied to early-stage burn scars. The optimal time for laser application for burn patients can be within 1 month after injury. Durometry and spectrocolorimetry were effective for assessing scars as objective modalities. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Carbon dioxide laser treatment for vulvovaginal atrophy in women treated for breast cancer: Preliminary results of the feasibility EPIONE trial

Quality of life preservation after anti-cancer therapy is a major challenge for breast cancer survivors. Approximately 42-70% of patients who receive systemic therapy for breast cancer, including endocrine therapy, will develop vulvovaginal atrophy (VVA). For these patients, the commonly proposed gel-based treatments for topical applications are restrictive. Recently, innovative, non-hormonal therapeutic approaches, such as laser therapy, have emerged. The purpose of this feasibility study is to investigate the safety and efficacy of CO2 laser therapy in women with a history of breast cancer. This prospective monocentric study included 20 patients with vulvovaginal atrophy who were treated at Henri Mondor University Hospital between 2017 and 2018. We included patients with a vaginal health index (VHI) score<15 and a contraindication for hormone administration due to a history of breast cancer. Two carbon dioxide laser sessions were used. The treatment was delivered using the following settings: vaginal tightening, FinePulse (pulse width 0.9ms), and energy density of 11.5J/cm2 that allows coverage of 70% of the targeted vaginal area to be treated. All patients had their follow-up visit at one (M1), three (M3), and six (M6) months after the first treatment to evaluate efficacy of the treatment on vulvovaginal atrophy. Vaginal health index score and female sexual distress (FSD) score were used to assess treatment efficacy and its impact on sexual quality of life. A score≥11 was associated with sexual dysfunction. The vaginal health index and female sexual distress scores were evaluated at baseline, M1, M3, and M6 of follow-up. The mean age of the patients was 56.1±8.8 years (range, 27-69 years). Seventeen of the 20 patients had experienced menopause (mean menopausal age, 51.25±1.5 years). At inclusion, the mean vaginal health index and the female sexual distress scores were 10.58±1.71 and 21.36±15.10, respectively. Fourteen out of 20 patients (70%) had FSD scores≥11 at the baseline. At M1, the mean vaginal health index score increased significantly to 13.42±2.3 (P=0.03), which represented an improvement of 21% from the baseline. A persistent and significant improvement in the vaginal health index score was observed at M6, with the score increasing to 16.75±4.23 post-treatment (P<0.0001), representing a 34% improvement from the mean baseline score. The mean female sexual distress at M1 was 19.83±13.57, representing a 7% decrease compared to the baseline scores (P<0.01). At M3, the female sexual distress significantly decreased to 13.88±15.58, representing an improvement of 35% (P=0.006). It increased to 10.35±14.7 at M6, representing an improvement of 52% (P=0.001). At M3, 35% of the patients had a female sexual distress score>11, and at M6, only 15% had a female sexual distress score>11. No side effects were reported during follow-up. This pilot feasibility study showed that carbon dioxide laser treatment appears to be an effective and safe method to improve the trophicity and decrease vaginal mucosal dryness in women with vulvovaginal atrophy that developed after systemic breast cancer therapy.

Comparative Study between Intralesional and Topical Botulinum Toxin A Combined with Fractional Carbon Dioxide Laser in Treatment of Hypertrophic Scars and Keloids (Comparative study)

Keloids and hypertrophic scars (HTS) are pathological scars that occur as a result of dermal injury and are characterized by persistent inflammation and fibrosis and excessive deposition of collagen and other fibroblast-derived extracellular matrix(ECM) proteins during skin healing.. Keloids Also hypertrophic scars representable an unreasonable tissue light of dermal damage described Toward nearby fibroblast burgeoning Furthermore overproduction of collagen. The point of this fill in is on analyze between the viability for intralesional versus topical anesthesia botulinum poison a joined together with fragmentary co2 laser in the medication of hypertrophic scars and keloids. This prospective clinical investigation included 10 patients with Keloids Also HTSs with no historical backdrop about medication six months former of the contemplate. Those whole scar lese greatness might have been partitioned under two halves. Person A large portion might have been dealt with with intralesional infusion for botulinum poison sort a once An month to an aggregate time of two months. The an alternate A large portion of the scar might have been approached with An course about two sessions from claiming co2 laser help at particular case month trailed Eventually Tom's perusing topical anesthesia requisition from claiming botulinumtoxin a for a catch up time of four months. Advanced photographas might have been performed for each tolerant previously, then after medicine.

Treatment of Nevus Sebaceous with Carbon Dioxide Laser Treatment Combined with Isotretinoin.

Nevus sebaceous(NS) is a congenital hamartoma of cutaneous structures including both surface epithelial and adnexal components. NS is usually removed by surgical excision. Here, we report an interesting case of NS on the face which showed good response to carbon dioxide (CO2) laser treatment combined with isotretinoin. A 22 - year - old female patient visited our dermatology clinic with skin lesion on the right cheek. Physical examination revealed multiple grouped, rice sized yellowish papules on the right cheek. Histopathologic findings revealed minimal papillomatosis, and acanthosis of epidermis with abundant of sebaceous gland proliferation in dermis. Based on these findings, we diagnosed her as NS. She was treated with CO2 laser for nevus ablation instead of surgical excision, because of location and size of the lesion with possibility of scar on face. After CO2 laser treatment, she took isotretinoin to prevent recurrence of NS. After 12 months later, lesion was well maintained without recurrence. Most investigators suggest that surgical excision is the treatment of choice of NS. However, remove nevus sebaceous by surgical excision leave linear scar. To minimize scar, there were several other treatment options include CO2 laser treatment.However, there was possibility of recurrence after laser treatment. To prevent recurrence, we treated her with isotretinoin and kept in good state for 12 months.

Localized carbon dioxide laser treatment of a recalcitrant oral ulceration in pemphigus vulgaris

Background Pemphigus vulgaris (PV) is a potentially fatal autoimmune, vesiculobullous, mucocutaneous disease. Recalcitrant oral lesions of PV can result in significant oral discomfort and interfere with eating and oral hygiene. Increasing the dosage of systemic medications to control such lesions results in higher risk of side effects. Currently, there is 1 published report describing 2 patients with healing of oral recalcitrant lesions after carbon dioxide (CO2) laser vaporization. Case Summary We describe here a case of a 51-year-old male patient diagnosed with PV through biopsy and direct immunofluorescence in 2013. At baseline, the patient had a history of premature ventricular contractions, allergy to penicillin, occasional alcohol intake, and no tobacco use. He was on analgesics for mouth pain. After further baseline laboratory testing, he was started on prednisone and mycophenolate, with good response. These medications were slowly tapered over the next 2 years, using clinical signs to guide the taper. At that time, because of the adverse effects of mycophenolate, the treatment was changed to intravenous immunoglobulin monthly infusions. During the 4.5-year follow-up period after diagnosis, while the systemic medications were being tapered, the patient's oral and skin lesions were well controlled, other than minor transient flares. However, a painful, ulcerated lesion on the facial gingiva between #11 and #12 was nonresponsive, even with use of topical clobetasol in trays. This recalcitrant lesion was vaporized with CO2 laser (3–5.5 W, continuous mode) under local anesthesia. This procedure resulted in complete healing of the ulceration, with no recurrence at the most recent 9-month postoperative examination. Conclusions Adjunctive procedures that can facilitate a decrease in the cumulative dosages of corticosteroids and immunosuppressants have great value in the management of PV. CO2 laser vaporization is a safe procedure with minimal morbidity and no long-term side effects and should be considered as an adjunctive treatment option for management of recalcitrant lesions in patients with oral PV. Pemphigus vulgaris (PV) is a potentially fatal autoimmune, vesiculobullous, mucocutaneous disease. Recalcitrant oral lesions of PV can result in significant oral discomfort and interfere with eating and oral hygiene. Increasing the dosage of systemic medications to control such lesions results in higher risk of side effects. Currently, there is 1 published report describing 2 patients with healing of oral recalcitrant lesions after carbon dioxide (CO2) laser vaporization. We describe here a case of a 51-year-old male patient diagnosed with PV through biopsy and direct immunofluorescence in 2013. At baseline, the patient had a history of premature ventricular contractions, allergy to penicillin, occasional alcohol intake, and no tobacco use. He was on analgesics for mouth pain. After further baseline laboratory testing, he was started on prednisone and mycophenolate, with good response. These medications were slowly tapered over the next 2 years, using clinical signs to guide the taper. At that time, because of the adverse effects of mycophenolate, the treatment was changed to intravenous immunoglobulin monthly infusions. During the 4.5-year follow-up period after diagnosis, while the systemic medications were being tapered, the patient's oral and skin lesions were well controlled, other than minor transient flares. However, a painful, ulcerated lesion on the facial gingiva between #11 and #12 was nonresponsive, even with use of topical clobetasol in trays. This recalcitrant lesion was vaporized with CO2 laser (3–5.5 W, continuous mode) under local anesthesia. This procedure resulted in complete healing of the ulceration, with no recurrence at the most recent 9-month postoperative examination. Adjunctive procedures that can facilitate a decrease in the cumulative dosages of corticosteroids and immunosuppressants have great value in the management of PV. CO2 laser vaporization is a safe procedure with minimal morbidity and no long-term side effects and should be considered as an adjunctive treatment option for management of recalcitrant lesions in patients with oral PV.

Recurrence of genitals warts in pre-HPV vaccine era after laser treatment

PurposeHuman papillomavirus (HPV) can cause condylomata acuminata, also known as genital warts. Our aim was to evaluate the long-term recurrence of genital warts after primary carbon dioxide laser treatment before the introduction of the vaccination against HPV.MethodsRecurrence rate and localization of genital warts were analysed in a retrospective study in 1798 women presenting with a new diagnosis of genital warts from 1992 to 2009 at a University hospital and had received laser treatment. Additionally, data on topography, pregnancy status, and cervical smear were available for women treated from 2003 to 2009 (n = 825, data subset 1) and systematic follow-up data for women treated in 2006 and 2007 (n = 242, data subset 2).ResultsMedian time from laser treatment to first recurrence was 14.6 weeks (data subset 2). The site most affected was the vulva (90.7%) followed by the perineum/perianal region (59.3%) and the vagina (47.3%). Abnormal Pap smear was observed in 22.6%. Systematic follow-up with a median follow-up time of 3.1 years revealed at least one recurrence in 68 (28.1%) of 242 women. Women with multifocal genital warts had a 2.9 times increased risk for recurrence compared to women with unifocal lesions (p = 0.01).ConclusionsNearly 30% of women presenting with genital warts experienced at least one recurrence after treatment with carbon dioxide laser. Multifocal lesions are the strongest indicator of recurrence. These data provide an important insight to recurrence rates of genital warts before HPV vaccination and underline the significance of a long-term follow-up and HPV vaccination.

Effects of carbon dioxide lasers on preventing caries: a literature review

This study aimed to review the effects of carbon dioxide lasers (λ = 10,600 nm) on preventing dental caries. A systematic search was performed of articles published in English through 2018 and archived in the PubMed, Scopus, and Web of Science databases. The keywords used to identify the relevant publications were ((CO2laser) OR (carbon dioxide laser)) AND ((dental caries) OR (tooth remineralization)). The titles and abstracts of the initially identified publications were screened. Duplicate records, case reports, reviews, and irrelevant studies were removed. Full texts that focus on the effects of carbon dioxide lasers on preventing dental caries were retrieved from publications. The search identified 543 potentially relevant publications. A total of 285 duplicate records were removed. Twenty-two articles investigating the effect of carbon dioxide lasers on enamel and dentin were included. Results of the studies showed that carbon dioxide lasers could cause chemical and morphological changes to mineralized tissues, including reduction of carbonate content and recrystallization of mineral structure. All studies showed that carbon dioxide lasers increased the microhardness and decreased the mineral loss of enamel (nine studies) and dentin (three studies). Two out of eight studies showed increased resistance to demineralization of enamel after carbon dioxide laser and fluoride treatment. All studies revealed that carbon dioxide laser and fluoride treatment reduced mineral loss of dentin against acid challenge. Carbon dioxide (10,600 nm) lasers can prevent demineralization of enamel and dentin. Furthermore, they have a synergistic effect with fluoride in preventing dentin caries.

318 Efficacy of Whole Scar Ablative Fractional Carbon Dioxide Laser Treatment in Patients with Large Area of Burn Scar: A Prospective Cohort Study

318 Efficacy of Whole Scar Ablative Fractional Carbon Dioxide Laser Treatment in Patients with Large Area of Burn Scar: A Prospective Cohort Study

Carbon dioxide laser treatment in burn-related scarring: A prospective randomised controlled trial

To investigate the effect of ablative fractional CO2 laser (AFCO2L)on burns scar appearance and dermal architecture at 6 weeks and up to 3-years post-treatment. Twenty adult patients with a burn-related scar were recruited. Inclusion criteria were a minimum scar area of 10 × 10 cm and Vancouver scar scale (VSS) score of >5 and ≥6 months since the time of injury. The region of scar was randomised to treatment/control zones. Treatment zones received 3 standardised laser treatments at 4- to 6-week intervals. All areas of scar received standard scar care. Outcome measures were recorded at baseline, 6-weeks post final treatment and up to 3 years post-treatment. Measures included blinded assessor VSS, Patient Scar Assessment Scale and histological tissue analysis. Nineteen and nine patients completed the short- and long-term studies, respectively. Clinical results revealed improvement in all scar areas over time. There was a statistically significant improvement in pain and itch in the treatment zone compared to the control zone at 6 weeks. Histological data revealed a significant increase in medium-sized collagen fibres at 6 weeks relative to the control site. Sub-group analysis according to scar age revealed greater histological improvement following laser treatment in immature scars relative to more mature scar. Results demonstrate that 3 treatments of AFCO2L significantly improve scar pain, itch and dermal architecture at 6 weeks post-treatment. Histological results suggest greater potential in treating immature scar. Further investigation into the timing of laser treatment could help assist treatment protocols.

Reconsideration of burn scar treatment

Since the mechanisms of scar formation are not fully understood, at least to date, there is no ideal method to prevent and treat scar after burn. In recent years, on the basis of conventional treatments, such as pressure therapy, external use of silicone gel, and intralesional injections of corticosteroids, the therapeutic approaches of fractional carbon dioxide laser treatment, injection of anti-vascular endothelial growth factor antibody, autologous fat transplantation, injection of botulinum toxin A, radiation therapy etc., have been gradually applied to treat burn scars. It is very important to select various methods individually and comprehensively according to the specific conditions of patients and scars. Meanwhile, it is necessary to continue to study and explore the possibility of targeted therapy in scar management.

Clinical effects of sequential laser treatments on early stage hypertrophic burn scars

Objective: To observe the clinical effects of sequential treatments of pulsed dye laser (PDL) and ablative fractional carbon dioxide laser on early stage hypertrophic burn scars. Methods: From January 2016 to December 2017, 221 patients with 228 hypertrophic scars in all parts of body within 6 months post healing, conforming to the study criteria and treated in our department, were included in this prospective study. They were first treated by PDL, repeated at an interval of one month until the vascularity score of scar fell below 2 points, and then treated by ablative fractional carbon dioxide laser, repeated at an interval of 3 months. Their start time and numbers of treatment and follow-up time were recorded. Before the first treatment (hereinafter referred to as before treatment) and at the last follow-up (hereinafter referred to as after treatment), the vascularity, thickness, and pliability of scars were scored by a self-made scar rating scale. The scores of patients with the observation time between 6 to18 months post healing were compared among scars of patients grouped by age, body site of scar, starting time of treatment and numbers of treatment. The laser speckle contrast imaging technique was used to measure the blood flow value of scars. The itching symptom of the scars was evaluated by the Verbal Rating Scale. The satisfaction to the final effects of the doctors and patients was investigated and scored separately by Likert scale after treatment. The therapeutic or adverse reactions were recorded during the treatment. Data were processed with paired t test, Mann-Whitney U test, Wilcoxon signed rank sum test, Kruskal-Wallis H test, and Spearman rank correlation analysis. Results: (1) The patients were treated on (64±36) d post healing, by PDL for (2.5±1.3) times and by ablative fractional carbon dioxide laser for (2.2±1.2) times. The follow-up time was (331±189) d. (2) The vascularity, thickness, pliability scores and total scores of scars were (1.4±0.9), (2.0±0.8), (1.7±0.8), and (5.0±2.1) points respectively after treatment, which were significantly lower than those before treatment [(4.1±0.7), (3.1±0.8), (3.0±0.9), and (10.2±2.0) points respectively, t=43.332, 24.968, 28.063, 46.394, P<0.01]. (3) Among the 123 scars from 120 patients with observation time between 6 to 18 months post healing, there were no statistically significant differences in the vascularity, thickness, pliability scores and total scores of scars among patients with different ages after treatment (χ(2)=4.339, 1.826, 1.375, 2.879, P>0.05). There was only significant difference in the pliability scores of scars among different body sites (χ(2)=13.530, P<0.05). There were statistically significant differences in the vascularity, thickness, pliability scores and total scores of scars with different starting time of treatment (χ(2)=30.725, 25.233, 25.119, 35.798, P<0.01). There were significantly positive correlation between starting time of treatment and the vascularity, thickness, pliability scores and total scores of scars (r=0.492, 0.442, 0.446, 0.532, P<0.01). There were statistically significant differences in the vascularity, pliability scores and total scores of scars with different numbers of treatment (Z=4.883, 4.910, 5.049, P<0.05). There were significantly negative correlation between number of treatment and the vascularity, thickness, pliability scores and total scores of scars (r=-0.176, -0.131, -0.191, -0.201, P<0.05). (4) The blood flow values were determined in 18 scars of 18 patients. The results showed that the blood flow values of scars after treatment were significantly decreased compared with those before treatment (t=7.230, P<0.01). (5) The pruritus scores of scars of patients after treatment were significantly decreased compared with those before treatment (Z=12.818, P<0.01). (6) There were significant differences between the satisfaction scores of doctors and the scores of patients after treatment (t=12.130, P<0.01). (7) After PDL treatment, there were some edema and purpura reactions for all the patients, and 11 (5.0%) patients had blisters. After ablative fractional carbon dioxide laser treatment, 4 (1.8%) patients had blisters, 5 (2.3%) patients suffered inflammatory reaction and erosion, and 9 (4.1%) patients suffered pigmentation. Conclusions: The scores of hypertrophic burn scars can be obviously improved by sequential treatments of PDL and ablative fractional carbon dioxide laser. The effects can be more obvious with the earlier starting time and more numbers of treatment. The laser treatments can also decrease the blood flow values and alleviate the pruritus of scars, with high satisfaction of both patients and doctors.

Fractional Carbon Dioxide Laser in Patients with Skin Phototypes III to VI and Facial Burn Sequelae: 1-Year Follow-Up.

Fractional carbon dioxide laser treatment in postburn scars is safe and effective, but high rates of hypochromia (35 percent) have been described in patients with skin phototypes V and VI after 2 months. The authors evaluated the efficacy and safety of fractional carbon dioxide laser treatment of burn scars in skin phototypes III to VI after 1 year, focusing on the incidence of hypochromia. A case series of 20 patients had skin phototypes III to VI with facial burn sequelae. They underwent three sessions of fractional laser. Laser fluence was increased in patients with no hypochromia and reepithelialization time of less than 15 days. Scars were evaluated after 2 months and 1 year by a five-item scale: color, hydration, surface irregularities, volume, and distensibility. The mean time for reepithelialization was 13.3 days (range, 2 to 40 days). The average final score of the scale increased from 4.4 before treatment to 7.33 after 1 year for physicians, and from 5.35 to 7.5 for patients. There was also an increase in the subjective score, which patients used to assess their skin. Two months after treatment, 60 percent of patients presented with punctate hypochromia. After 1 year, only 15 percent of patients still had mild hypochromia; all of them had skin phototypes V and VI. Nevertheless, they were satisfied with overall bleaching of the skin. Fractional carbon dioxide laser improved skin quality. Late punctate hypopigmentation should be considered a possible complication in patients with skin phototypes V and VI. Therapeutic, IV.

Treatment of Facial Hypopigmented Scars by the Laser Hole Technique Using a Nonfractional Carbon Dioxide Laser in Asians.

Facial hypopigmented scars are usually characterized by white color and a glossy surface. To correct the two problems simultaneously, the authors attempted to induce persistent postinflammatory hyperpigmentation for color and to build multiple pitted scars like facial skin pores for texture. This study describes a laser hole method using a traditional nonfractional carbon dioxide laser for treatment of facial hypopigmented scars and evaluates the clinical results. Forty-three facial hypopigmented scars in 27 patients were treated, excluding protruding or thick scars. A carbon dioxide laser was set in the superpulse mode by continuous delivery. Multiple small holes were made in the scar at a distance of 1 to 3 mm. Each laser hole was produced by continuously repeated shots at one point until the deep dermis was involved. All lesions were exposed without protection. At 1 or 2 months after initial treatment, the remaining hypopigmentation was treated by the same procedure. Treatment sessions were performed once for nine scars, twice for 22 scars, and three times for 12 scars. In most cases, postinflammatory hyperpigmentation was slightly diminished but maintained until the last follow-up. The fine irregular surface with multiple pitted scars was similar to that of normal skin. Scar improvement evaluation showed marked or excellent in 39 scars (90.7 percent) and minimal or partial in four deep or thick scars. The laser hole technique using a nonfractional carbon dioxide laser may be an excellent option for simultaneously treating the color and texture of superficial or thin hypopigmented facial scars in Asians.

The effects of recombinant human epidermal growth factor containing ointment on wound healing and post inflammatory hyperpigmentation prevention after fractional ablative skin resurfacing: A split-face randomized controlled study.

Epidermal growth factor (EGF) is one of the important peptides in wound healing process. The effects of EGF have been increasingly studied in various types of ulcers. However, data on postablative laser resurfacing wound is still limited. To evaluate the effects of the topical EGF ointment on wound healing process and postinflammatory hyperpigmentation (PIH) prevention after fractional ablative laser resurfacing. This is a randomized split-face study. Nineteen healthy subjects were enrolled and completed follow up protocol. Patients received single treatment of fractional carbon dioxide laser on both cheeks. After randomization, each patient was assigned to apply one side of the face with topical EGF ointment and another side with petrolatum. Wound healing was evaluated by duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss on the daily follow up period of seven days after treatment. PIH was evaluated at 2, 3weeks and 1, 2months follow up by photographs and melanin index. Most of patients were female with Fitzpatrick skin phototype III to V. Comparing with control (petrolatum), EGF treated side showed no significant difference in duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss (P-value=.58, .22, .78, and .51, respectively). Incidence of PIH was 52.6% on EGF side and 57.9% on petrolatum side, however, it was not statistically different (P=.56). The melanin index was also not different as well (P=.96). Topical EGF might provide significant wound healing stimulation for chronic wound more than acute wound. Further studies, especially in post laser wound or other cosmetic purposes are needed.

Effectiveness of modified transsection and longitudinal suture in epicanthoplasty

To introduce a modified transsection and longitudinal suture in epicanthoplasty and summarize its effectiveness. The clinical data of 119 patients underwent epicanthoplasty with modified transsection and longitudinal suture and with a follow-up time over 6 months between February 2014 and December 2016 were retrospectively analyzed. There were 8 males and 111 females with an average age of 22.7 years (range, 18-38 years). The epicanthus was as eyebrow type in 12 cases, as eyelid type in 57 cases, as tarsalis type in 39 cases, and as backward type in 11 cases. The narrow degree of epicanthus included mild (the lacrimal caruncle covered size was less than 1/3) in 42 cases, moderate (the lacrimal caruncle covered size was between 1/3 and 2/3) in 58 cases, and severe (the lacrimal caruncle covered size was over 2/3) in 19 cases. One hundred and thirteen patients were treated by blepharoplasty at the same time. The new canthus was located on the basis of the inner canthus physiological aesthetics. Through a short transverse incision, dislocated orbicularis oculi muscle near medial canthal ligament and the fiber between the medial canthal ligament and skin were completely released; then the medial canthal ligament was shortened precisely and the incision was tension-free sutured followed the Langer's line near eyes. All the incisions healed by first intention. All patients were followed up 6 months to 2 years (mean, 8.6 months). The bilateral hypertrophic scar on both bilateral medial canthal incisions happened in 3 patients at 3-6 months after operation; and the scarring gradually subsided at 10 months after the diprospan injections and the siliconegel and carbon dioxide laser treatment. Good effectiveness were obtained in the other patients, whose inner intercanthal distance significantly narrowed, both of the horizontal lid fissure length increased, the lacrimal caruncle fully exposed, and no obvious scar could be seen. The modified transsection and longitudinal suture in epicanthoplasty has the advantages of simple design, easy operation, minimally invasive, inconspicuous scar, and obvious, stable, and lasting postoperative effectiveness.

Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars.

Ablative fractional carbon dioxide laser resurfacing is a well-established treatment for acne scars. However, there are limited consensus and guidelines regarding the procedure, such as its treatment plan, efficacy, and safety. In this study, we performed a systematic review to assess the efficacy and safety of the fractional carbon dioxide laser treatment procedure, and to provide evidence-based recommendations concerning its practical use on atrophic acne scars. A comprehensive search was performed in, EMBASE, Ovid, Web of Science, and Cochrane databases, using the keywords "scar(s)," "acne vulgaris," "carbon dioxide," and "fraction* laser(s)" for the period from January 1987 to December 2016. The initial literature search identified 337 articles. The final selection included 30 studies: 12 retrospective studies and 18 prospective randomized clinical trials. Ablative fractional carbon dioxide laser is an effective therapy for the treatment of acne scars. The treatment session, interval, and parameters should be customized for each patient. Combination therapy should be considered for ice-pick type acne scars. The use of dermocosmetics in pre- and postoperative care may be beneficial to patients.