YAG Fractional Laser Research Articles

Efficacy and safety of CO2 fractional laser versus Er:YAG fractional laser in the treatment of atrophic acne scar: A meta-analysis and systematic review.

To date, a consensus on the relative efficacy and safety of CO2 fractional laser versus erbium-doped yttrium aluminum garnet (Er:YAG) fractional laser treatments for atrophic acne scars has not been reached. This meta-analysis aims to systematically assess and compare their effectiveness and safety in clinical practice. For this meta-analysis, we conducted comprehensive searches in Pubmed, Embase, and Cochrane databases, covering publications from their inception up to August 2023. Our focus was on studies comparing fractional CO2 laser with Er:YAG fractional laser treatments for atrophic acne scars. We excluded duplicate publications, research lacking full-text access, incomplete data, or cases where data extraction was not feasible. Additionally, animal experiments, reviews, and systematic reviews were not considered. Data analysis was performed using STATA 15.1. Eight studies (seven randomized controlled trials (RCTs) and a retrospective study) were included in this meta-analysis. The sample size ranged from 28 to 106 with a total of 418 patients, including 210 in the CO2 fractional group and 208 in Er:YAG fractional group. The pooled results showed that the effective rate of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (OR = 1.81, 95% CI: 1.08-3.01) and the downtime of CO2 fractional laser in treating atrophic acne scar was significantly shorter than that of Er:YAG fractional laser (Weighted Mean Difference (WMD) = -2.11, 95% CI: -3.11 to -1.10). In addition, VAS of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (WMD = 1.77, 95% CI: 1.32-2.21) and the duration of erythema of CO2 fractional laser in treating atrophic acne scar was significantly longer than that of Er:YAG fractional laser (WMD = 1.85, 95% CI: 1.63-2.07). However, there was no significant difference in the duration of pain and incidence of PIHbetween CO2 fractional laser and of Er:YAG fractional laser. When it comes to treating atrophic acne scars, CO2 fractional laser demonstrates superior efficacy and leads to shorter downtime. However, it is important to note that CO2 fractional laser treatments tend to result in higher pain intensity and may carry a higher risk of post-treatment pigmentation compared to Er:YAG fractional laser procedures.

Fractional Er:YAG laser versus fractional CO2 laser in the treatment of immature and mature scars: a comparative randomized study

Fractional Er:YAG laser versus fractional CO2 laser in the treatment of immature and mature scars: a comparative randomized study

Trapdoor Deformity Correction Post Nasal Bilobed Flaps for Basal Cell Carcinoma Reconstruction With Multiple Laser Modalities.

In case of excision of nasal basal cell carcinoma (BCC), bilobed flaps are considered the criterion standard of reconstruction for defect less than 15 mm in size. However, there is still a risk of trapdoor deformity formation, of which its treatment is less discussed. A 44-year-old woman who was diagnosed with nasal BCC and underwent tumor excision with bilobed flap reconstruction presented with trapdoor deformity postoperatively. The computed Vancouver Scar Scale was 7. After early intervention of multiple laser modalities, including 2 sessions of 585-nm pulsed dye laser with a fluence of 9 J/cm2, pulse duration of 6 milliseconds, and spot size of 6 mm, 2940-nm Er-yttrium aluminum garnet (YAG) laser with a pulse energy of 800-900 mJ, repetition rate of 8-9 Hz, and laser spot size of 3-7 mm, and 5 sessions of 1064-nm Nd:YAG fractional picosecond laser with a pulse energy of 2.30-2.70 mJ, repetition rate of 8 Hz, and laser spot size of 6 mm from 5 to 23 weeks postoperatively, the Vancouver Scar Scale score improved to 1, with significant reduction of trapdoor scar erythema and puffiness. Although BCC is often curable, tumor excision causes unsatisfactory appearance satisfaction problem, owing to the apparent location of the lesion. Factors, such as sebaceous tissue thickness, reconstruction over multiple aesthetic subunits of nose, and damage to nasal cartilage framework structure during tumor removal, may increase the risk of trapdoor formation. Early intervention with multiple laser treatment can significantly revise the deformity.

Efficacy of 1064nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser and 2940nm fractional erbium laser for severe acne with acne scar: a case report

Introduction: Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives to conventional therapies. Recently, laser therapy has been widely used in the treatment of acne vulgaris due to its effectiveness and safety as it provides a more rapid response with less rate of recurrence, specifically 1064nm Nd: YAG laser. Few studies have investigated laser combinations. Combination 1064nm Nd: YAG and 2940nm fractional erbium laser for severe acne with acne scar has not been reported. Case report: We report a case of severe acne with acne scars in a 21-year-old female, skin type IV, treated using 1064nm Nd: YAG laser in five sessions and 2940nm fractional erbium laser two sessions. Reduction of acne lesions counts and acne scars improvement prominent after Nd:YAG laser at least four sessions. Our patient's acne scars improved not significantly after 2940nm fractional erbium laser. Acne remission was sustained through the follow-up period. There were no post-inflammatory hyperpigmentation and no exacerbation of acne lesions after the procedures. Conclusion: 1064nm Nd: YAG laser is very effective for mild to severe acne and improves new acne scars. While 2940nm fractional erbium laser is more effective for mature scars.

Experimental Analysis of Vaginal Laxity in Rats Treated With a Combination of Er:YAG Fractional Lasers and AMSC-MP

Introduction: Vaginal laxity, a symptom of pelvic floor dysfunction observed in women, has many negative biological and psychological impacts. Laser treatments and stem cell-based therapies are emerging therapeutic methods for treating this condition. This study aimed to determine changes in vaginal laxity in model rats using a combination therapy of erbium-doped yttrium aluminium garnet (Er:YAG) fractional lasers and topical treatment with amniotic membrane stem cell metabolite products (AMSC-MP). Methods: The experimental animal population comprised 36 female white rats (Rattus norvegicus; 2-day-post-vaginal-delivery rats) allocated into the following four groups (n=9): K1, untreated two-day-post-vaginal-delivery rats; K2, two-day-post-vaginal-delivery rats treated with topical gel without AMSC-MP; P1, two-day-post-vaginal-delivery rats treated with Er:YAG fractional lasers and topical gel without AMSC-MP; P2, two-day-post-vaginal-delivery rats treated with Er: YAG fractional lasers and topical gel containing AMSC-MP. Immunohistochemical (IHC) examination was carried out for the expression and activity of heat shock protein 70 (HSP-70), collagen-1, tissue inhibitors of metalloproteinase 1 (TIMP-1) and matrix metalloproteinase 1 (MMP-1), as well as vaginal mucosal thickness. Results: There was a significant difference (P<0.05) in the expression of HSP-70 among all groups except K2 and P1 (P>0.05); there was no significant difference in type I collagen and TIMP-1 expression between the groups (P>0.05); there was a significant difference (P<0.05) in MMP-1 activity, with the activity in the K2 group (5.79±0.83) being higher than that in the P1 group (4.44±1.82) and that in the K1 group (5.74±1.03) being higher than that in the P2 group (4.24±1.55). Also, there was a significant difference in the thickness of the vaginal mucosa in all groups except K2 and P1 (P>0.05). Conclusion: Er:YAG fractional laser and AMSC-MP combination therapy improved vaginal laxity in model rats by increasing Hsp70 expression and vaginal mucosal thickness and decreasing MMP-1 activity.

Erbium:YAG fractional laser ablation improves cutaneous delivery of pentoxifylline from different topical dosage forms

Topical application of pentoxifylline (PTX) would enable targeted treatment of radiation-induced skin fibrosis. However, PTX is hydrophilic with limited partitioning into the stratum corneum. The objective of this study was to investigate whether use of Erbium:YAG fractional laser ablation and different topical dosage forms (solution, hydrogel and patch) could be used to improve PTX cutaneous delivery as opposed to transdermal permeation. Initial results confirmed that fractional laser ablation significantly increased PTX delivery from each dosage form compared to passive controls. Delivery efficiencies of ∼ 30% were achieved with each dosage form but a large proportion of PTX permeated across the skin; thus, fluences were decreased to create shallower micropores, their depth being linearly dependent on fluence. The hydrogel was selected as the optimal formulation and PTX delivery efficiencies were further increased (44%-67%) by reducing the amount of hydrogel applied (better mimicking conditions of use). As this resulted in PTX depletion in the formulation, a loss of dependence of delivery on laser fluence was observed. These findings suggest that fractional laser ablation at moderate fluences enables an effective and targeted cutaneous delivery of PTX from a hydrogel formulation, which can be easily produced without the need for complex equipment.

35101 Combination treatment of transdermal micro-jet using Er:YAG laser and ablative fractional 10,600-nm carbon dioxide laser for acne scar

Background: Various treatment modalities have been used to treat acne scars. Transdermal micro-jet using Er:YAG laser is a new concept called TDDS (Trans-Dermal Drug Delivery System) that sprays small amounts of drugs into the dermis without needles. Carbon dioxide (CO2) fractional laser is one of the most effective and commonly used tool for acne scar. This study aimed to evaluate the efficacy and safety of combination therapy transdermal micro-jet using Er:YAG laser and CO2 fractional laser for acne scar. Materials and methods: Fourteen patients with acne scars were treated 3 sessions of combining transdermal micro-jet using Er:YAG and CO2 fractional laser with 3∼4 week interval. Patients treated with a spot size of 4 mm, fluence of 2.0∼4.8 J/cm2 was performed by transdermal micro-jet using Er:YAG laser. Then CO2 fractional laser was performed. A punch biopsy was performed before and after treatment in 4 patients for histologic analysis. Clinical photographs were obtained before treatment and at follow-up. Two blinded dermatologists assessed the clinical improvement in terms of acne scar using a quartile grading scale. Results: All patients experienced both subjective and objective improvement. The patient satisfaction surveys showed that 12 patients (85.7%) perceived a moderate to excellent improvement (>50%) in their condition. No adverse reactions were reported. Histopathologic evaluation with hematoxylin and eosin staining showed new collagen generation in the dermis. Conclusion: Our preliminary findings suggest a safe therapeutic alternative for acne scars.

Comparative Study Between the efficacy of Long-Pulsed Neodymium- YAG Laser and Fractional Co2 Laser in the Treatment of Striae Distensae.

Introduction: Stretch marks, or striae distensae (SD), are the lesions of the dermis caused by its linear atrophy at the sites of stretching. They occur in more than 70% of pregnant women and adolescents as a result of cutaneous stretching. This study aimed at evaluating and comparing the clinical and histological efficacy of the fractional CO2 laser versus the long pulsed (LP) Nd: YAG laser in the treatment of striae alba. Methods: Thirty female subjects having bilateral symmetrical stretch marks were managed by the LP Nd: YAG laser on the right side and the fractional CO2 laser on the left side. The laser treatment course consisted of 3 sessions with an interval of 3 weeks. The patient satisfaction score and the Global Aesthetic Improvement Scale (GAIS) were employed in the study in order to assess the improvement 3 months after therapy. Punch biopsies measuring 4 mm were extracted from one lesion on each side at baseline and after the last treatment session by 3 months to evaluate the thickness of both collagen and epidermis Results: Clinical improvement was more significant in the lesions treated by the LP Nd:YAG laser than those treated with the fractional CO2 laser. The patient satisfaction score and the GAIS were higher with a statistically significant value in the side treated by the LP Nd:YAG laser. Collagen and epidermal thickness increased more in the LP Nd: YAG laser-treated lesions in comparison to their thickness in the fractional CO2 laser-managed lesions, but this difference did not have a statistical significance. Conclusion: The clinical efficacy of the LP Nd-YAG laser exceeded that of the fractional CO2 laser in the treatment of striae alba without severe side effects in spite of the insignificant histological difference between the two lasers.

The use of CO2 ablative fractional laser, non-ablative picosecond fractional lasers 1064 nm and 755 nm and needle mesotherapy in combined therapy to reduce stretch marks and skin laxity. A clinical case

Stretch marks are a common problem and a challenge for cosmetologists and aesthetic medicine doctors. Due to the complex etiopathogenesis and difficulties in their reduction, specialists use various therapeutic methods. In this study, the described case confirms the effectiveness of selected combined therapy in reducing stretch marks and skin laxity. Impressive surgical results were obtained with the implementation of combined therapy consisting of the use of non-ablative Nd:YAG fractional laser and alexandrite laser in picosecond technology, CO2 fractional ablative laser and needle mesotherapy treatments.

Hair Loss Treatment Using Erbium:YAG Fractional Laser with Hair Growth-promoting Solution

Hair Loss Treatment Using Erbium:YAG Fractional Laser with Hair Growth-promoting Solution

Targeted cutaneous delivery of etanercept using Er:YAG fractional laser ablation.

The aim was to investigate the feasibility of using Er:YAG fractional laser ablation to enable topical cutaneous delivery of etanercept (ETA). Preliminary investigations into the effect of fluence on micropore depth, measured by full-field optical coherence tomography, were followed by quantitative experiments to determine ETA delivery and its cutaneous biodistribution from solution and hydrogel formulations. Visualization studies were performed using confocal laser scanning microscopy and an ETA-fluorescein conjugate. Micropore depth was linearly dependent on laser fluence. However, use of a single pulse or "pulse stacking" (i.e. multiple pulses) to apply a given fluence affected pore depth; this was accommodated mathematically by including a "stacking factor". ETA delivery into porated skin from solution and 0.8% Carbopol® formulations was equivalent: increasing ETA content in the gels from 0.5 to 1 and 2% increased ETA delivery linearly (Formulations 7-9: 5.12±0.95 to 7.48±1.45 and 11.2±2.2µg/cm2, respectively; 10% FAA, 89.9J/cm2, 5ppp); occlusion further increased ETA delivery from Formulation 9 to 23.17±6.62µg/cm2. Cutaneous biodistribution studies demonstrated that ETA was delivered in therapeutically relevant amounts to the epidermis and dermis. Topical laser-assisted delivery of ETA might expand its range of clinical indications to include recalcitrant but not widespread psoriatic plaques (clinical trial underway).

Comparison of a novel wound dressing vs current clinical practice after laser resurfacing

There are many postprocedure skin care options, but no consensus on the best formulation to optimize healing. Silicone gels have only been used to treat keloids and hypertrophic scars and typically applied after the wound has healed. This study compared the healing response after fractional ablative erbium laser resurfacing with a petrolatum-based ointment and a silicone gel. A randomized, open-label, split-face study was performed. Ten subjects underwent Erbium:YAG (Sciton) fractional laser resurfacing. Patients were randomized to apply a petrolatum-based gel or a silicone gel (Stratacel® ; Stratpharma) on either the right or left side of the face. Subjects applied the products twice a day for 7days and were evaluated in person 7, 30, and 60days postprocedure. Subjects reported on the overall general aesthetic outcome, perceived pain, itch, and tightness via questionnaires using the Global Aesthetic Improvement Scale and the Wrinkle Severity Rating Scale (WSRS). All subjects healed without complications. By day 60, there was no difference in signs and symptoms of healing between the two different dressing approaches. However, patients treated with the silicone gel had less post-treatment erythema and hyperpigmentation. A novel silicone gel resulted in reduced signs of erythema and hyperpigmentation postprocedure, without an increase in adverse events. Additionally, the silicone gel dries to form a thin, full contact film and can be covered with sunscreen or cosmetics once dry. This new silicone gel presents a good option for postprocedure care after ablative fractional laser resurfacing.

Er:YAG fractional laser ablation for cutaneous co-delivery of pentoxifylline and d-α-tocopherol succinate: A new approach for topical treatment of radiation-induced skin fibrosis

Radiation induced fibrosis is a common side-effect after radiotherapy. Pentoxifylline is reported to reverse radiation injuries when used in conjunction with D-α-tocopherol. However, pentoxifylline has a short half-life, limited oral bioavailability, and induces several systemic adverse effects. The objective of this study was to investigate the feasibility of using Er:YAG fractional laser ablation to enable simultaneous cutaneous delivery of pentoxifylline and D- α -tocopherol succinate from poly(lactide-co-glycolide) microparticles prepared using the freeze-fracture technique. In vitro release experiments demonstrated the different release profiles of the two molecules, which were influenced by their very different lipophilicities and aqueous solubilities. Experiments were then performed to investigate the effect of laser fluence on pore depth and so determine the pore volume available to host the topically applied microparticles. Application of the pentoxifylline and D-α-tocopherol succinate containing microparticles, prepared with RESOMER® RG 502H, to laser porated skin for 48 h, resulted in simultaneous delivery of pentoxifylline (69.63 ± 6.41 μg/cm2; delivery efficiency 46.4%) and D-α-tocopherol succinate (33.25 ± 8.91 μg/cm2; delivery efficiency 22.2%). After deposition into the micropores, the poly(lactide-co-glycolide) microparticles containing pentoxifylline and D-α-tocopherol succinate could serve as an intraepidermal depot to enable sustained drug delivery after micropore closure and thereby reduce the need for repeated microporation.

Comparison of Picosecond Pulsed Nd:YAG Laser and Fractional Laser for the Treatment of Acne Scars

Comparison of Picosecond Pulsed Nd:YAG Laser and Fractional Laser for the Treatment of Acne Scars

Needle-free cutaneous delivery of living human cells by Er:YAG fractional laser ablation

ABSTRACTBackground: Dermatological diseases, including most skin cancers and rare genetic conditions frequently originate in the epidermis. Targeted, topical cell-based therapy is a promising therapeutic strategy. Here, we present the first report demonstrating that fractional laser ablation enables local ‘needle-free’ intraepidermal delivery of living human cells.Methods: The cells penetrated porcine ear skin via microchannels created by Er:YAG fractional laser ablation; cell delivery was quantified using a haemocytometer. Cutaneous distribution was confirmed visually by laser scanning confocal microscopy and histological analysis.Results: Total cell delivery (sum of amounts permeated and deposited) after 24 h increased from 5.7 ± 0.1 x105 to 9.6 ± 1.6 x105 cells/cm2 when increasing pore density from 300 to 600 pores/cm2, – corresponding to 19- and 32-fold increases over the control. At 600 pores/cm2, cell deposition was 136-fold greater than cell permeation – the latter most likely due to transport from micropores into appendageal pathways. Production of GFP post-delivery confirmed cell remained viability.Conclusion: The results demonstrate the feasibility of using controlled laser microporation to achieve local ‘needle-free’ cutaneous delivery of living human cells to the epidermis and dermis. This raises the possibility of using this technique for targeted new approaches for dermatological therapy in these regions.

Evaluation of the effectiveness of erbium yttrium–aluminum–garnet fractional laser, carbon dioxide therapy and platelet-rich plasma in treating striae distensae

Objective This study aims to compare the efficiency of erbium: yttrium–aluminum–garnet (Er: YAG) laser, carboxytherapy, and platelet-4rich plasma (PRP) in the treatment of striae distensae. Background Striae distance or striae distensae are common dermal scars characterized by flattening and atrophy of the epidermis, and result in considerable aesthetic concern. Patients and methods The study was conducted on 60 female patients with striae in the area between the diaphragm and the knee, whose ages ranged between 16 and 50 years. Cases were collected from the inpatient and outpatient dermatology clinics, Shebin El-Kom Teaching Hospital, in the period from October 2016 to April 2017. Detailed history, and full general and dermatological examination were done; photography and CO2 injection were performed on 20 patients (group A), while PRP injection was done to the resting 20 (group B), and 20 patients were treated by Er: YAG laser (group C). All the potential side effects were discussed with all patients’ group prior to their participation. Results The mean age of the patients was 26.39±11.51 years. The most common sites affected by striae distensae were the abdomen, thighs and the hips. There was no significant difference regarding the patients’ skin type, duration of striae, and the result at the end of treatment sessions (P>0.05). However, there was a statistically significant difference (P Conclusion The clinical improvement of striae distensae can be obtained with the use of the Er: YAG fractional laser. The results of this study demonstrated the safety and efficacy as well as low-incidence side effects of Er: YAG fractional laser in the treatment of striae distensae as compared with CO2 and PRP. So, more randomized, controlled studies are needed to further evaluate the efficacy of lasers for the treatment of striae distensae among different skin types and different ages.

Significant skin-tightening by closure of fractional ablative laser holes.

Ablative fractional laser treatment uses thousands of very small laser beam wounds to damage a fraction of the skin, which stimulates tissue remodeling. Each open micro-wound heals without scarring, but the amount of skin tightening achieved is limited. This animal study was performed to test the hypothesis that immediate temporary closure of fractional laser wounds could increase skin tightening after fractional ablative laser treatment. Four adult swine were used for the study; 98 square test sites (3 × 3 cm) were tattooed on the abdomen and flanks of each pig. An ablative fractional Erbium:YAG laser (Sciton Profile, Sciton Inc, Palo Alto, CA) was used to treat the test areas. A laser micro-spot fluence of 375 J/cm2 was delivered in 150-250 microseconds pulses, resulting in an array of ablation channels extending 1.5 mm deep into the skin, with a spot size of 250 µm, with 10% treatment density. Immediately following laser exposure the resulting holes were closed using a stretched elastic adhesive dressing, which, when applied, recoiled and compressed the diameter of the ablation holes. The compressive dressings were removed after 7 days. This procedure was compared to removing the same amount of skin (10%) mechanically by specially designed 19 gauge coring needles, as well as to the same laser and coring methods without compression closure. Area and shape of test sites were measured by digital photography before and 28 days after treatment. Data analysis included compensation for animal growth, as measured by increase in the area of the untreated control sites. All treated and control sites healed within a week, without scarring evident at 28 days. Laser treatment combined with compressive wound closure caused significant shrinkage at 28 days compared with untreated control sites. The treated skin area was reduced by 11.5% (P = 0.0001). Needle coring with wound closure produced similar, significant shrinkage (8%, P < 0.0021), whereas laser and needle coring treatment without closure did not result in significant area reduction (P = 0.1289) compared with untreated control sites. Significant skin tightening can be achieved by immediate temporary non-invasive wound closure after short pulse Er:YAG fractional ablative laser treatment, as well as after mechanically removing skin with a coring needle. This approach may improve skin tightening after ablative laser treatments. Further clinical studies are necessary to confirm successful application in humans. Lasers Surg. Med. 50:64-69, 2018. © 2017 Wiley Periodicals, Inc.

Lasers and intense pulsed light for the treatment of rosacea

Rosacea is a common skin disease clinically characterized by skin flushing, persistent erythema, papules/pustules and telangiectasia. Laser therapy is an ideal option for the treatment of rosacea-associated telangiectasia and rhinophyma. The most commonly used lasers include 585-/595-nm pulsed dye lasers, long-pulsed 1 064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, carbon dioxide (CO2) laser, erbium:yttrium-aluminum-garnet (Er:YAG) laser, fractional laser, and so on. Intense pulsed light and pulsed dye laser have shown favorable therapeutic effects on rosacea-associated erythema and telangiectasia with high safety and short downtime. Long-pulsed Nd:YAG laser can only be used to target wide blood vessels and to treat resistant telangiectasia. CO2 laser, Er:YAG laser and fractional laser can be used to improve rhinophyma. In clinic, combined treatment using multiple lasers may result in better therapeutic outcomes. Key words: Rhinophyma; Lasers; Lasers, dye; Therapeutic uses; Intense pulsed light

Er:YAG fractional laser as a percutaneous absorption promoter for controlled delivery of antibody in vitro

Er:YAG fractional laser as a percutaneous absorption promoter for controlled delivery of antibody in vitro

Comparison of Q-switched Nd:YAG laser and fractional carbon dioxide laser for the treatment of solar lentigines in Asians

Comparison of Q-switched Nd:YAG laser and fractional carbon dioxide laser for the treatment of solar lentigines in Asians