Rejuvenation of the male scalp using 1,927 nm non-ablative fractional thulium fiber laser

A Prospective, Split-Face, Comparative Study of Combined Treatment With Fractional Microneedle Radiofrequency and Nonablative 1927-nm Fractional Thulium Fiber Laser for Wrinkle Treatment

BACKGROUND

Fractional microneedle radiofrequency (FMR) and nonablative 1927-nm fractional thulium fiber laser (TFL) are widely used for skin rejuvenation treatment.

OBJECTIVES

To investigate the efficacy and safety of combined treatment with both devices for wrinkles.

PATIENTS AND METHODS

Twenty-five patients with wrinkles were enrolled. One side of the face was treated with FMR alone, while the other side was treated with a combination of FMR and TFL. Each treatment consisted of 3 sessions at four-week intervals and patients were followed up 12 weeks after the last treatment. Overall improvement was assessed by patient global assessment (PGA) and investigator global assessment (IGA). Depression scores for the evaluation of wrinkles were objectively assessed by Antera 3D system.

RESULTS

Both sides of the face led to clinical improvement in both mean PGA and IGA. Combination treatment demonstrated a greater improvement in both mean PGA and IGA compared with FMR alone. In addition, wrinkle grading scales and depression scores showed greater improvement in the combination group than in FMR alone.

CONCLUSION

This study demonstrated that FMR and TFL comprise a good combination treatment for the treatment of wrinkles because both treatments have a synergistic effect on wrinkle improvement.

Successful Treatment of Scalp Micropigmentation With 1064 nm Picosecond Nd:YAG Laser

BACKGROUND AND OBJECTIVES

Scalp micropigmentation (SMP) is a useful technique that applies permanent camouflage for hair loss and scarring. However, suboptimal outcomes necessitate removal. To date, there have been no reports of SMP removal with a picosecond laser. In this report, we demonstrate the safety and efficacy of 1064 nm picosecond neodymium yttrium aluminum garnet (Nd:YAG) laser for the removal of SMP.

STUDY DESIGN/MATERIALS AND METHODS

This was a case series of four patients who presented with undesirable SMP. Following induction of adequate cutaneous anesthesia, a 1064 nm picosecond Nd:YAG laser was applied to all surface areas with SMP. Post-operative care consisted of 1% dimethicone ointment applied twice daily to the affected areas for 3-7 days. Patients were evaluated after 3-4 weeks and additional treatment sessions were undertaken if necessary.

RESULTS

Clearance of SMP was achieved within 1-3 treatment sessions in all cases. There were no unexpected adverse events.

CONCLUSION

Picosecond Nd:YAG laser is an excellent treatment option for undesirable SMP. It is safe and effective and typically requires fewer treatment sessions than traditional tattoo removal. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

A Randomized, Split-Face, Double-Blind Comparison Trial Between Fractionated Frequency-Doubled 1064/532 nm Picosecond Nd:YAG Laser and Fractionated 1927 nm Thulium Fiber Laser for Facial Photorejuvenation

BACKGROUND AND OBJECTIVE

Fractionated lasers are a popular therapeutic option for facial photorejuvenation. In this study, we compare the safety, tolerability, and efficacy of a fractionated frequency-doubled 1064/532 nm picosecond Nd:YAG fractionated picosecond laser (FPL) versus a fractionated 1927 nm thulium fiber laser (TFL) for facial rejuvenation.

STUDY DESIGN/MATERIALS AND METHODS

This was a double-blind, randomized, split-face comparison study involving 20 subjects. Facial halves were randomized to receive either FPL or TFL treatment. Three treatments were delivered at 1-month intervals. Subjects were followed up for 1, 3, and 6 months post-final treatment session and evaluated by blinded, non-treating investigators for dyspigmentation, erythema, keratosis, texture, and rhytids on a standardized scale. Subjects also recorded a quantitative daily diary rating healing progress for 14 days after every treatment session.

RESULTS

Statistically significant improvements in elastosis, erythema, keratosis, dyschromia, and skin texture were noted in both treatment groups. There were no significant differences detected in clinical efficacy between the two groups. Subject daily dairies revealed statistically significant differences in tolerability during the immediate 14-day post-operative recovery period. The facial half treated with FPL displayed significantly less redness on days 3 and 4; significantly less swelling on day 5; significantly less crusting on days 1 through 9; significantly less peeling on days 3 through 9; and significantly less itch on days 4 and 7. There were no unexpected adverse effects observed.

CONCLUSION

Both FPL and TFL are safe and effective treatment options for facial rejuvenation. FPL may be associated with significantly less downtime. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Fractional 1,927 nm Thulium Laser Plus Photodynamic Therapy Compared and Combined for Photodamaged Décolleté Skin: A Side-by-Side Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Décolleté photodamage is a common condition typically treated with light and energy-based devices. This study investigated the efficacy and safety of a fractional 1,927 nm thulium laser (TL) alone and combined with photodynamic therapy (PDT).

STUDY DESIGN/MATERIALS AND METHODS

In a 12-week follow-up study, participant décolletés were divided into four treatment areas and randomized to receive a single treatment with field-directed TL, PDT, combination TL-PDT, or lesion-directed curettage control. All actinic keratoses (AKs) underwent lesion-directed curettage before randomization. TL was delivered at 20 mJ/mb, 500 mJ/cm² fluence, 5 W, and 8 (n = 6 pts.) or 16 (n = 6 pts.) passes. PDT was performed with 16% methyl aminolevulinate (MAL) creme incubated for 3 h, followed by red light-emitting diode light at 37 J/cm² . Outcome measures included clinical assessment of overall photodamage and specific subcomponents, assisted by optical coherence tomography (OCT) imaging.

RESULTS

Twelve women with moderate to severe photodamage on the décolleté and a cumulative total of 184 thin grade I AKs were included. Field-directed treatments TL and combination TL-PDT equally improved the overall photodamage, mottled pigmentation, and rhytides compared with lesion-directed control (P < 0.05). The skin texture improved by TL alone and was further improved by combining TL and PDT (P < 0.05). Median AK complete responses were similar for field-directed interventions TL-PDT (100%), TL (90%), PDT (82%), and lesion-directed curettage control (52%) (P = 0.464). Patients presented with mild local skin responses, slightly more pronounced when combining TL with PDT versus individual treatments (P < 0.05). No scarring or adverse events were observed.

CONCLUSIONS

The 1,927 nm fractional thulium laser is an effective, tolerable, and safe field-directed treatment for décolleté photodamage. Provided alone, TL proved to be as effective as combined TL-PDT for overall photodamage, while a greater improvement in skin texture was achieved using TL and PDT in combination. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Treatment of burn scars in Fitzpatrick phototype III patients with a combination of pulsed dye laser and non-ablative fractional resurfacing 1550 nm erbium:glass/1927 nm thulium laser devices

Introduction:

Burn scars cause cosmetic disfigurement and psychosocial distress. We present two Fitzpatrick phototype (FP) III patients with burn scars successfully treated with combination pulsed dye laser (PDL) and non-ablative fractional lasers (NAFL).

Case 1:

A 30-year-old, FP III woman with a history of a second-degree burn injury to the bilateral arms and legs affecting 30% body surface area (BSA) presented for cosmetic treatment. The patient received three treatments with 595 nm PDL (7 mm, 8 J, 6 ms), six with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4–8 passes) and five with the 1927 nm thulium laser (10 mJ, 30% density, 4–8 passes). Treated burn scars improved significantly in thickness, texture and colour.

Case 2:

A 33-year-old, FP III man with a history of a second-degree burn injury of the left neck and arm affecting 7% BSA presented for cosmetic treatment. The patient received two treatments with 595 nm PDL (5 mm, 7.5 J, 6 ms), four with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4–8 passes) and two with the 1927 nm thulium laser (10 mJ, 30% density, 4–8 passes). The burn scars became thinner, smoother and more normal in pigmentation and appearance.

Discussion:

Our patients’ burn scars were treated with a combination of PDL and NAFL (two wavelengths). The PDL targets scar hypervascularity, the 1550 nm erbium:glass stimulates collagen remodelling and the 1927 nm thulium targets epidermal processes, particularly hyperpigmentation. This combination addresses scar thickness, texture and colour with a low side effect profile and is particularly advantageous in patients at higher risk of post-procedure hyperpigmentation.

Conclusion:

Our cases suggest the combination of 595nm PDL plus NAFL 1550 nm erbium:glass/1927 nm thulium device is effective and well-tolerated for burn scar treatment in skin of colour.

While all scars can be bothersome, burn scars can be particularly troubling. They can be large, itchy, painful and limit range of motion. Patients with medium and darker skin tones may be more likely to develop dark and discoloured scars due to burns and other scarring injuries. In our case series, we used two types of lasers to treat thick, darkly pigmented burn scars in two patients with medium and darker skin tones. While the pulsed dye laser targets the redness and thickened aspects of scars to restore a more normal appearance, the non-ablative fractional resurfacing laser creates microscopic zones of controlled injury to resurface scars, stimulate new collagen growth, improve texture and lighten excess pigmentation. Treatments were performed once a month for 6–12 months. Using these lasers in combination, our treatment method made our patients’ scars thinner, smoother and more evenly coloured over time, resulting in a more natural appearance. This multi-modal approach was a safe and effective no-downtime method for the improvement of scars in skin of colour patients.

Penile Lichen Sclerosus Treated with 1927 nm Thulium Fiber Laser and Photodynamic Therapy: A New Possible Therapeutic Approach

OBJECTIVE

We treated two patients with recalcitrant lichen sclerosus (LS) of the penis with a combination of 1927 nm thulium fiber laser and methyl-aminolevulinate (MAL) photodynamic therapy (PDT).

BACKGROUND DATA

Therapy of LS is based on topical potent steroids, emollients, and topical calcineurin inhibitors. Circumcision is effective, but not always accepted. PDT represents a valid therapeutic option in refractory cases, but there are no reports about the association with 1927 nm thulium laser in the treatment of this pathology.

MATERIALS AND METHODS

We used to treat the affected areas with a combination of 1927 nm thulium fiber laser and MAL PDT in the same section. The same protocol was repeated after 1 month.

RESULTS

An improvement of lesions after the first treatment and complete cleaning after 3 months of therapy were noted. Results were maintained in the follow-up after 2 years.

CONCLUSIONS

Association with 1927 nm thulium laser was able to amplify the effectiveness of PDT and to promote tissue remodeling. Despite the positive response to our case, clinical studies are lacking and further analysis could be performed on a wider population to better define correct dosage and safety profile. Further, it is necessary to compare this procedure with other treatments to establish the real effectiveness.

Energy-Based Devices in Male Skin Rejuvenation

Men seek cosmetic procedures for vastly different reasons than women. Men often seek discrete cosmetic services with little downtime. Male skin structure generally differs from female skin structure. Dermatologists should consider subtle differences in the psyche of the male cosmetic patient.