Ultrapulse CO2 Laser Research Articles

Pyogenic granuloma treated with continuous wave CO2 laser followed by ultrapulsed CO2 laser ablation

Pyogenic granuloma treated with continuous wave CO2 laser followed by ultrapulsed CO2 laser ablation

Characterization of a novel standardized human three-dimensional skin wound healing model using non-sequential fractional ultrapulsed CO2 laser treatments.

At present, there is no standardized in vitro human skin model for wound healing. Therefore, our aim was to establish and characterize an in vitro/ex vivo three-dimensional (3D) wound healing model, which we employed to analyze the effects of dexpanthenol on wound healing and gene regulation. The novel human 3D skin wound healing model using scaffold and collagen 3D organotypic skin equivalents was irradiated with a non-sequential fractional ultrapulsed CO2 laser. These standardized injured full-thickness skin equivalents enable qRT-PCR, microarray, and histological studies analyzing the effect of topically or systemically applied compounds on skin wound healing. These human laser-irradiated skin models were found to be appropriate for in vitro wound healing analysis. Topical treatment of skin wounds with a 5% dexpanthenol water-in-oil emulsion or two different 5% dexpanthenol oil-in-water emulsions clearly enhanced wound closure compared to laser-irradiated untreated control models. To find out whether this positive effect is caused by the active substance dexpanthenol, laser-irradiated skin models were cultured in calciumpantothenate containing medium (20 μg/ml) compared to skin equivalents cultured without calciumpantothenate. 3D models cultured in calciumpantothenate revealed considerably faster wound closure compared to the control models. Quantitative RT-PCR studies showed enhanced mRNA expression of MMP3, IL1α, keratin-associated protein 4-12 (KRTAP4-12), and decreased expression of S100A7 in laser-irradiated skin models cultured in medium containing calciumpantothenate. This novel standardized human 3D skin wound healing model proves useful for topical pharmacological studies on wound healing and reveals new insights into molecular mechanisms of dexpanthenol-mediated effects on wound healing. In addition, these novel 3D model systems can be used to monitor ex vivo effects of various laser systems on gene expression and morphology of human skin.

Clinical curative effect observation of ultra pulse CO2 laser combined with collagen dressing in treatment of primary cutaneous amyloidosis

Objective To investigate the clinical efficacy and safety of ultra pulse CO2 laser combined with collagen dressing in treatment of cutaneous amyloidosis. Methods A total of 68 cases of primary cutaneous amyloidosis patients according to the different treatment methods was divided into two groups: the control group (n=33 cases) that was given acitretin capsules oral and topical compound flumetasone ointment packet treatment, and observation group (n=35 cases) with ultra pulse CO2 laser combined with collagen dressing external treatment. Two groups were observed in patients with curative effect and adverse reaction. Results Disease of integral observation group after treatment was significantly lower than the control group(t=3.12, P<0.05). The observation group had the efficiency of [88.6%(31/35)] that was significantly higher than that of control group[17/33(51.5%), χ2 = 11.23, P<0.01]. The observation group had significantly shorter healing time [(5.38 ± 1.81)d] compared to the control group [(10.75 ± 2.06)d, t=11.39, P<0.01]. The observation group did not have recurrence, which was significantly different from the control group (χ2=4.90, P<0.05). Conclusions Ultra pulse CO2 laser combined with collagen dressing in treatment of primary cutaneous amyloidosis is a kind of effective treatment methods with remarkable curative effect and less adverse reactions. It is worthy of clinical application. Key words: Amyloidosis/TH; Skin diseases/TH; Lasers, gas/TU; Collagen/AD

Combined Carbon Dioxide Laser with Photodynamic Therapy for Nodular and Superficial Basal Cell Carcinoma

Basal cell carcinomas (BCCs) are often seen by general practitioners, plastic surgeons, and dermatologists in the outpatient setting. Photodynamic therapy (PDT) and CO2 laser when used as monotherapy have been successfully used to treat small BCC, with greatest success in the superficial histological subtype but have limitations compared to surgical excision due to a limited depth of penetration of PDT (2 mm absorption) limiting efficacy. We describe our experience of dual-modality treatment improving efficacy, cosmetic outcomes, and minimizing recurrence. One hundred ten patients with a total of 177 lesions mainly on the head and neck were treated with combined therapy using an UltraPulse CO2 laser and PDT using methyl aminolevulinate (METVIX) at the same sitting, with repeat PDT 1 week later. We evaluated recurrences, cosmetic outcomes, patient satisfaction, and costs. The mean age of patients was 67 years. The mean follow-up period was 32.2 months, with a range of 7.7 to 68.5 months. Eighty six lesions were followed up for more than 3 years. A total of 177 lesions were diagnosed and treated. Only biopsy-proven BCCs were included in this study. Histologically, 34 (19.2%) were superficial subtype, 50 (28.2%) nodular, 9 (5.08%) infiltrative, 7 (3.95%) morpheic, 3 (1.69%) mixed, and in 74 (41.8%) diagnosis was simply BCC. All lesions responded to treatment as assessed by clinical evaluation with regular follow-up. The total recurrence-free rate was 97.1%. In 88.1% lesions, a single cycle of treatment was required; 9.03% had 2 cycles and 0.56% underwent 3 cycles. In 3 of the patients, no data were available. Recurrences were noted in 5 (2.82%) cases. All recurrences were treated successfully, all but one using repeat laser-PDT. One patient underwent surgical excision. No significant complications were encountered, although mild hypopigmentation was occasionally seen and some discomfort is experienced with PDT. Combined CO2 laser and PDT have equivalent cure rates to surgery for BCCs--notably of the nodular subtype--these modalities acting synergistically. This strategy provides cure often with scarless outcomes as illustrated. Laser with PDT is most appropriate for patients who value excellent cosmetic outcomes and where avoidance of an invasive procedure is an important factor. In addition, this modality comes into its own for specific groups of patients, such as those on Warfarin or those with diffuse or multiple lesions.

Laser treatment of giant xanthelasma palpebrarum.

Xanthelasma palpebrarum is the most common cutaneous xanthoma. It typically presents in middle-aged and older adults, most often around the eyelids. The diagnosis is made clinically. Giant xanthelasmas palpebrarum are xanthelasmas that extensively affect the superior and inferior bilateral eyelids. Many techniques have been put forward for treating these lesions (surgical, laser, and chemical techniques), but we describe our experience in the treatment of giant xanthelasmas by ultrapulsed CO2 laser. Between 2009 and 2012, in the Division of Plastic and Reconstructive Surgery at the University of Palermo, 12 patients with giant xanthelasmas were treated using a CO2 laser. The laser parameters are as follows: frequency 20Hz, energy 75mJ, and power 1.5W. Each laser session lasts 15min; the treatment consists of three or four sessions that are carried out at intervals of 15days. Patients were followed up after 2, 6, and 12months. This technique is rapid and it is accepted very well by patients. The only disadvantage is a long healing time (10-15days). The ultrapulsed CO2 laser, in experienced hands, is an excellent device that enables the complete removal of giant xanthelasmas with a minimally invasive but very effective technique.

Dystrophic Calcification and Accentuated Localized Argyria After Fractionated Carbon Dioxide Laser Therapy of Hypertrophic Scars

Fractionated, ultrapulsed carbon dioxide (CO2) laser therapy is a powerful tool for the treatment of scars. Common adverse effects of this therapeutic modality have been previously documented. We describe 2 unreported adverse effects of ultrapulsed CO2 laser treatment of mature scars in a patient previously treated with silver-impregnated dressings. A teenage survivor of toxic epidermal necrolysis presented with faint but diffuse dyschromia clinically and histologically consistent with localized argyria secondary to silver-impregnated dressings used years earlier. The patient was subsequently treated with fractionated CO2 for her scarring, but her hyperpigmentation worsened with each treatment. A subsequent biopsy specimen revealed a zone of dystrophic calcification with adjacent pseudo-ochronotic fibers that were not appreciated on biopsy specimens taken before CO2 laser treatment, suggesting unique complications not previously reported. We present 2 unique complications secondary to ultrapulsed, fractionated CO2 laser treatment in a patient previously treated with silver-impregnated dressings: (1) the appearance of pseudo-ochronotic fibers in areas of worsening pigmentation and (2) evidence of dystrophic calcification limited to columns of fractionated laser ablation. Therefore, a history of argyria or treatment with silver-impregnated dressings should be considered before treatment with fractionated CO2 lasers.

Application of laser CO2 for the treatment of xanthelasma palpebrarum

MethodWe treated 12 patients with bilateral xanthelasmas using an ultra-pulse CO2 laser. They were all extirpated, with no differences between the upper and lower eyelids. There were no cases of ectropion or bleeding. All the patients expressed a high level of satisfaction. DiscussionThe use of the laser CO2 is a good therapeutic option for treating xanthelasmas especially those located in the lower eyelid, and in young people. It is a safe treatment for delicate periorbital regions, with a low risk of visible scars, and fewer recurrences. The technique can be performed outside the operating room avoiding the anxiety that is created by surgical intervention.

A randomized guinea pig study on external cell growth factors after fractional ultrapulsed CO2 laser therapy

Background and objectives: The Fractional Ultrapulsed CO2 laser has been successfully used in treating fine wrinkles, acne scars, and photoaged skin. However, the downtime typically lasts a week or more. The purpose of this study was to observe the efficacy of external cell growth factors after Fractional Ultrapulsed CO2 laser therapy. Methods: The back skin of 20 male guinea pigs were divided into four regions after hair removal, then these four regions were irradiated with Fractional Ultrapulsed CO2 laser, respectively. These 80 incised wounds were randomly divided into three therapeutic groups and a control group. The general condition of the wound healing was observed grossly. The determination of physiological functions was done and biopsies were harvested at different time points to compare the change of skin flexibility and fibroblasts number. Results: The wound healing time of therapeutic groups shortened when compared with the control group. The flexibility of skin and the number of fibroblasts were also more than the control group. The effects of combined application of rhEGF and rb-bFGF therapeutic group were most conspicuous. Conclusions: Combined application of rhEGF with rb-bFGF could be more beneficial to the wound after Fractional Ultrapulsed CO2 laser therapy. It could accelerate the wound healing and increase the flexibility of wound skin, so the significance was important to direct clinical application.

Novel approach with fractional ultrapulse CO2 laser for the treatment of upper eyelid dermatochalasis and periorbital rejuvenation

Fractional ultrapulse CO2 laser resurfacing improves photodamage, wrinkles, and acne scarring by ablation of damaged tissue with subsequent regeneration and remodeling of collagen. In this study, the authors examined the efficacy and safety of fractional CO2 laser and introduce a novel approach to the treatment of upper eyelid dermatochalasis. We treated 20 patients with low and moderate upper eyelid dermatochalasis. We did photographic analysis of results by measuring distance of upper eyelid fold and lateral eyebrow in vertical axis from a horizontal line joining medial and lateral canthi. All patients underwent UltraPulse CO2 laser (Microxel MX 7000) resurfacing at upper eyelid, superior to eyebrow, and in periorbital area. Measurements were taken before and at 3 and 6 months after the laser treatment. We evaluated results at 3 and 6 months after laser treatment and found that the UltraPulse CO2 laser induced elevation of eyelid crease and brow position (1.62 ± 0.69 and 2.110 ± 0.66 mm at 3 months; 1.63 ± 0.68 and 2.300 ± 0.67 mm at 6 months, respectively) as compared to before the treatment. Side effects were mild, patients reported minor crusting and oozing that resolved within 48 to 72 h, edema (1-2 days), and moderate postoperative erythema resolved within 4 days. These data illustrate the safety and efficacy of fractional ultrapulse CO2 laser in the treatment of low and moderate upper eyelid dermatochalasis with added advantage of nonsurgical brow lift.

高能超脉冲CO2激光与液氮冷冻治疗化脓性肉芽肿疗效比较

高能超脉冲CO₂激光与液氮冷冻治疗化脓性肉芽肿疗效比较

高能超脉冲CO2激光与液氮冷冻治疗化脓性肉芽肿疗效比较

高能超脉冲CO₂激光与液氮冷冻治疗化脓性肉芽肿疗效比较

63 Intravascular laser blood irradiation of different spectral and frequency range in the correction of hormonal imbalance of patients with bronchial asthma

For patients seeking aesthetic rejuvenation of the eyes, transconjunctival blepharoplasty is an effective means of dealing with proptotic lower eyelid fat. For dermatochalasis of infraorbital skin, Ultrapulse carbon dioxide (CO2) laser resurfacing can be used simultaneously with blepharoplasty to “tighten” periorbital skin. This article describes the technique, results, and complications in a series of 101 patients. Histological and electron microscopic study of laser wounding provides an understanding of tissue biophysics unique to human eyelid skin. The entire procedure can be performed with the laser, by starting with a 0.2 mm CO2 laser handpiece to incise the conjunctiva and resect fat, then switching to a computer pattern generator (CPG) for skin resurfacing. Meticulous hemostasis, avoidance of the inferior oblique muscle, and complete fat excision are the mainstays of this procedure. The technique has been extremely safe and free from complications of ocular morbidity, bleeding, ectropion, scleral show, hypopigmentation, skin slough, or scarring. There was one case of herpes simplex. Duration of healing averaged 7 weeks when the CPG was used. In contrast, the single-spot, manual sweep handpiece significantly prolonged erythema to 11 weeks or more. The incidence of hyperpigmentation was 16%, and equal in patients undergoing transconjunctival blepharoplasty with resurfacing and those receiving periorbital laser resurfacing alone. Treatment with hydroquinone cleared all patients. Histological study showed variance in total eyelid skin thickness, from 483 to 1,371 μms with epidermis comprising 63.5 μm on average. The first pass of the laser characteristically exfoliates the epidermis in a clean plane, 60 to 80 μm, with nominal dermal effect. A second pass produces dermal coagulation of approximately 40 μms, sparing adnexal structures. With a second pass of the laser, electron microscopy confirms collagen fibril contraction in the reticular dermis, with a 30% increase in diameter and a 9% contraction in periodicity. At the same level, microvasculature is preserved. Transconjunctival lower lid blepharoplasty, performed with Ultrapulse CO2 laser incision and skin resurfacing, avoids morbidity typically associated with standard subciliary blepharoplasty, and with no increase in ocular or laser-related sequelae. For resurfacing, two passes with the CPG enhances dermal collagen contraction, and dermal viability and collagen contraction are confirmed by microscopic examination.

Aplicación de láser CO2 para el tratamiento de xantelasmas palpebrales

MethodWe treated 12 patients with bilateral xanthelasmas using an ultra-pulse CO2 laser. They were all extirpated, with no differences between the upper and lower eyelids. There were no cases of ectropion or bleeding. All the patients expressed a high level of satisfaction. DiscussionThe use of the laser CO2 is a good therapeutic option for treating xanthelasmas especially those located in the lower eyelid, and in young people. It is a safe treatment for delicate periorbital regions, with a low risk of visible scars, and fewer recurrences. The technique can be performed outside the operating room avoiding the anxiety that is created by surgical intervention.

Efficacy of CO2 laser combined with 32P-patch contact brachyradiotherapy for the treatment of keloids

To investigate the efficacy of CO2 laser combined with 32P-patch contact brachyradiotherapy for the treatment of keloids. From 2001 to 2006, 121 cases with 151 keloids, which reoccurred after treatment with more than 2 methods, underwent continuous CO2 laser treatment to remove the hypertrophic scar tissue, following by ultra-pulse CO2 laser to treat the fresh granulation tissue. After wound healing, 32P-patch contact brachyradiotherapy was used for the lesion, 0.5-1 MBQ/cm2 for 72-96 hours, every 1-2 months. 2-3 treatment were applied. Among the 151 keloids, good result was achieved in 111 keloids, and effective result in 40 keloids. Adverse effect included hyperpigmentation in 21 lesions and hypopigmentation in 32 lesions. The patients were followed up for 2-6 years without relapse. CO2 laser combined with 32P-patch contact brachyradiotherapy is an effective and safe method for the treatment of recalcitrant keloids.

Random fractional ultrapulsed CO2 resurfacing of photodamaged facial skin: long-term evaluation

Although numerous papers have recently been published on ablative fractional resurfacing, there is a lack of information in literature on very long-term results. The aim of this retrospective study is to evaluate the efficacy, adverse side effects, and long-term results of a random fractional ultrapulsed CO2 laser on a large population with photodamaged facial skin. Three hundred twelve patients with facial photodamaged skin were enrolled and underwent a single full-face treatment. Six aspects of photodamaged skin were recorded using a 5 point scale at 3, 6, and 24months after the treatment. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Three hundred one patients completed the study. All analyzed features showed a significant statistical improvement 3months after the procedure. Three months later all features, except for pigmentations, once again showed a significant statistical improvement. Results after 24months were similar to those assessed 18months before. No long-term or other serious complications were observed. From the significant number of patients analyzed, long-term results demonstrate not only how fractional ultrapulsed CO2 resurfacing can achieve good results on photodamaged facial skin but also how these results can be considered stable 2years after the procedure.

Comparison of a fractional micro-plasma radio-frequency technology versus fractional ultrapulsed CO2 laser for the treatment of atrophic acne scars

Objective To compare the efficacy of and adverse reactions to a fractional micro-plasma radio-frequency technology versus fractional ultrapulsed CO2 laser in the treatment of atrophic acne scars.Methods Twenty-one patients with atrophic acne scars were enrolled in this study.Half of each subject's face was treated with micro-plasma,and the other half with fractional ultrapulsed CO2 laser,for one session.Treatments were randomly administered in a split-face manner.The efficacy and adverse effects were evaluated 6 months after the treatment by using the following outcome parameters:ECCA grading scale (echelle d' evaluation clinique des cicatrices d'acne),degrees of post-treatment pain and edema,time taken for crusting and durations of inflammatory erythema,patients' subjective rating of improvement in scar by using a quartile grading scale.A non-parametric rank test was conducted to compare the efficacy and adverse effects between the two treatments.A scar model was established on both ears of a New Zealand big ear rabbit,and treated with the CO2 laser and micro-plasma respectively,immediately followed by the resection of scar tissue for the observation of histological changes.Results A decrease of ECCAscore was observed in 90.5％ (19/21) of the patients after micro-plasma treatment,and in 86.7％ (18/21) after CO2 laser treatment; no significant difference was observed in the response rate (P ＞ 0.05).In detail,ECCA score decreased by 31.5％ (from 50.71 to 34.76 ) after micro-plasma treatment,compared to 29.9％ (from 53.57 to 38.10) after CO2 laser treatmet.Mild edema was observed after micro-plasma treatment,with the duration of erythema and crusting being 13.95 days and 6.95 days,respectively,compared to 45.81 days and 10.10 days respectively,after CO2 laser treatment.Pigmentation occurred in none of the patients after micro-plasma treatment,but in 19％ after CO2 laser treatment.Animal experiment showed that microscopic ablation zones were broad and shallow after micro-plasma treatment,but narrow and deep after CO2 laser treatment.Conclusions Fractional micro-plasma and CO2 laser are both effective for the treatment of atrophic acne scars,but the former seems to have less side effects with a lower incidence of pigmentation. Key words: Cicatrix; Micro-plasma; Fractional laser

Does ultra-pulse CO2 laser reduce the risk of enamel damage during debonding of ceramic brackets?

This study seeks to evaluate the enamel surface characteristics of teeth after debonding of ceramic brackets with or without laser light. Eighty premolars were bonded with either of the chemically retained or the mechanically retained ceramic brackets and later debonded conventionally or through a CO(2) laser (188W, 400Hz). The laser was applied for 5 s with scanning movement. After debonding, the adhesive remnant index (ARI), the incidence of bracket and enamel fracture, and the lengths, frequency, and directions of enamel cracks were compared among the groups. The increase in intrapulpal temperature was measured in ten extra specimens. The data were analyzed with SPSS software. There was one case of enamel fracture in the chemical retention/conventional debonding group. When brackets were removed with pliers, incidences of bracket fracture were 45% for the chemical retention, and 15% for the mechanical retention brackets. No case of enamel or bracket fracture was seen in the laser-debonded teeth. A significant difference was observed in ARI scores among the groups. Laser debonding caused a significant decrease in the frequency of enamel cracks, compared to conventional debonding. The increase in intrapulpal temperatures was below the benchmark of 5.5 °C for all the specimens. Laser-assisted debonding of ceramic brackets could reduce the risk of enamel damage and bracket fracture, and produce the more desirable ARI scores without causing thermal damage to the pulp. However, some augmentations in the length and frequency of enamel cracks should be expected with all debonding methods.

A Chinese experience of fractional Ultrapulsed CO2 laser for skin rejuvenation

Background and objectives: The ablative fractional CO2 laser has been successfully used in treating photoaged skin in the Caucasian population. However, its application in Asian skin has not been widely reported. The purpose of this study is to observe the efficacy and safety of the protocol ‘ActiveFX’ for photodamaged facial skin in Chinese patients. Methods: A non-sequential fractional ultrapulsed CO2 laser with specific settings is used in addition to a new computer pattern generator (CPG). Twenty patients received a single-session, single-pass, ablative fractional treatment on a split face. The patients were evaluated at baseline, and 1 and 3 months (M1, M3) after the treatment using a quartile grading scale. They were also asked to assess their overall satisfaction using a 4-point scale. The improvement of the coarse wrinkles was also quantitatively analyzed with a 3D in vivo imaging system. Results: At M1 and M3, the blinded investigator rated global improvement as 2.8 ± 0.95 and 3.00 ± 0.73, which was consistent with the patients' assessment (2.55 ± 0.83 at M1 and 3.15 ± 0.88 at M3). The roughness analysis (Rz) demonstrated a significant decrease in periorbital wrinkles (p < 0.0001). Minimal and reversible adverse side effects and rapid healing were noted. Conclusions: Non-sequential fractional ultrapulsed CO2 laser resurfacing (ActiveFX) is considered an excellent treatment modality for photodamaged Chinese facial skin.

Application of ultra-pulse CO2 laser in blepharoplasty

Objective To explore the applied values of ultra-pulse CO2 laser in blepharoplasty by shortening procedure time, improving the surgical satisfactory result and alleviating the operative and postoperative hemorrhage. Methods 238 patients with bulging, redundant skin in the upper and lower eye lids, including brow lift (26 cases), double eye lid surgery (48 cases), and lower lash line incision (159 cases). Laser incision was implemented with the ultra-pulse CO2 laser system. Results Bleeding was scant in 238 cases and hence local swelling subsided quickly with excellent healing. No eetropion, he-matoma and diplopia ever occurred. 3 months to 3 years follow-up showed satisfactory for all the patients. The result was quite satisfied in clinical observation and postoperative follow-up. Conclusion Utilizing the ultra-pulse CO2 laser in blepharoplasty has confirmed the satifisfatory surgical results, decreasing the surgical time, and reducing the intraoperative and postoperative bleeding. Key words: Ultra-pulse CO2 laser ; Eye bag removal (lower blepharoplasty) ; Hemorrhage bleeding ;

Orbit high energy ultrapulse CO2 laser in treatment of congenital melanocytic nevus

Objective To valuate the effect of high energy ultrapulse CO2 laser on congenital melanocytic nevi of the orbit. Methods 46 patient with congenital melanocytic nevi of eyelid, 58 le-sions were vaporized with high energy ultrapulse CO2 laser. The area of the largest one was 3.0 cm×6.0 cm, and the smallest one was 0.3 cm×0.3 cm, with average of 1.3 cm×2.0 cm. The depth of the vaporizing reached the layer of lowest skin, even the orbicularis, aponeurosis and conjunctiva of tarsus, till no melanin on the wound in view, tried the best to reserve the normal follicle of eyelash. There was no eschar and bleeding on the wound during the procedure. Followed up lasted for 1 - 56 months, with average 12.9 months. Results 44 of 46 patients were satisfactory to the effect of the laser. The most of scars resulted from the vaporizing with the laser became evenness and smooth (50/58). The edge of eyelid looked normal after the laser. The excellent result was observed in 84.5 % (49/58) lesions, good in 10.3 % (6/58), and improved in 5.2 % (3/58). The overall effect was 94.8 % (55/58). And eyelashes were getting growth. Conclusion The treatment of con-genital melanocytic nevus of eyelid with high energy ultrapulse CO2 is a good method. But to be careful in selecting the lesions that may not he too large. Key words: Laser; Congenital melanocytic nevus; Eyelid