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Murray TN, Hu JK, Friedman PM. Full-face and neck resurfacing with a novel ablative fractional 2910 nm erbium-doped fluoride glass fiber laser for advanced photoaging. Lasers Surg Med 2024; 56:249-256. [PMID: 38353284 DOI: 10.1002/lsm.23764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Ablative fractional lasers have long been considered the gold standard for facial resurfacing for advanced photoaging. These lasers offer an improved safety profile compared to traditional ablative lasers but typically require more treatment sessions given their fractional approach. In this study, we evaluate a new novel 2910 nm erbium-doped fluoride glass fiber laser (2910 nm fiber laser) (UltraClear; Acclaro Medical) for full-face and neck resurfacing for the treatment of advanced photoaging. METHODS Twenty-two healthy subjects aged 44-80 years presenting for advanced facial photoaging and rhytides were enrolled in the study. All subjects received three full-face and neck, multipass treatments utilizing the 2910 nm fiber laser spaced 6-8 weeks apart. Subjects were asked to rate the average level of pain during the treatment. At 90 days following subjects' third treatment subjects evaluated their improvement using a Global Aesthetic Improvement Scale (GAIS) and rated their satisfaction with the treatment. Evaluation of pretreatment and posttreatment photos was completed by two blinded physician reviewers. Reviewers were asked to identify the pretreatment and posttreatment photographs and to rate the degree of improvement utilizing a GAIS. RESULTS Fifteen participants completed the study; six were exited from the study (withdrew or lost to follow-up). The average subject GAIS score for overall appearance was 3.8. The average subject satisfaction level at follow-up was 4.8. The average subject pain score was 4.9. One blinded physician reviewer correctly identified 100% of subjects' posttreatment photographs, while the second blinded reviewer correctly identified 93%. Blinded evaluation of digital photographs revealed an average GAIS score of 3.2. Posttreatment skin responses included pin-point hemorrhage, erythema, edema, and soft tissue crusting lasting 5-7 days. There were no instances of infection, scarring or hypopigmentation. There were two instances of temporary hyperpigmentation. CONCLUSIONS Treatment with the novel 2910 nm fiber laser is safe and effective in treating advanced photoaging and rhytides. Three treatments produced moderate to marked improvement with high patient satisfaction and treatment was associated with less discomfort and downtime compared to conventional fractional ablative lasers.
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Affiliation(s)
- Taryn N Murray
- Dermatology and Laser Surgery Center, Houston, Texas, USA
- Dermatology & Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie K Hu
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paul M Friedman
- Dermatology and Laser Surgery Center, Houston, Texas, USA
- Department of Dermatology, McGovern Medical School, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Dermatology, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas, USA
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Ghanbari M, Rezazadeh G. Thermo-vibrational analyses of skin tissue subjected to laser heating source in thermal therapy. Sci Rep 2021; 11:22633. [PMID: 34799649 PMCID: PMC8605001 DOI: 10.1038/s41598-021-02006-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
Laser-induced thermal therapy, due to its applications in various clinical treatments, has become an efficient alternative, especially for skin ablation. In this work, the two-dimensional thermomechanical response of skin tissue subjected to different types of thermal loading is investigated. Considering the thermoelastic coupling term, the two-dimensional differential equation of heat conduction in the skin tissue based on the Cattaneo–Vernotte heat conduction law is presented. The two-dimensional differential equation of the tissue displacement coupled with the two-dimensional hyperbolic heat conduction equation in the tissue is solved simultaneously to analyze the thermal and mechanical response of the skin tissue. The existence of mixed complicated boundary conditions makes the problem so complex and intricate. The Galerkin-based reduced-order model has been utilized to solve the two-sided coupled differential equations of vibration and heat transfer in the tissue with accompanying complicated boundary conditions. The effect of various types of heating sources such as thermal shock, single and repetitive pulses, repeating sequence stairs, ramp-type, and harmonic-type heating, on the thermomechanical response of the tissue is investigated. The temperature distribution in the tissue along depth and radial direction is also presented. The transient temperature and displacement response of tissue considering different relaxation times are studied, and the results are discussed in detail.
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Affiliation(s)
- Mina Ghanbari
- Mechanical Engineering Department, Urmia University of Technology, Urmia, Iran.
| | - Ghader Rezazadeh
- Mechanical Engineering Department, Faculty of Engineering, Urmia University, Urmia, Iran.,South Ural State University, Lenin prospect 76, Chelyabinsk, Russian Federation, 454080
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Goldie K, Kerscher M, Fabi SG, Hirano C, Landau M, Lim TS, Woolery-Lloyd H, Mariwalla K, Park JY, Yutskovskaya Y. Skin Quality - A Holistic 360° View: Consensus Results. Clin Cosmet Investig Dermatol 2021; 14:643-654. [PMID: 34163203 PMCID: PMC8214518 DOI: 10.2147/ccid.s309374] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022]
Abstract
Introduction Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/aesthetic physicians was convened. Methods A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again. Consensus was defined as: strong consensus = greater than 95% agreement; consensus = 75% to 95% agreement; majority consent = 50% to 75% agreement; no consensus = less than 50% agreement. Results There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person's chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient. Instead, improving skin quality EPCs can require a multilayer treatment strategy. Conclusion This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients' perception for the need for aesthetic treatment.
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Affiliation(s)
| | - Martina Kerscher
- Division of Cosmetic Science, Department of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany
| | | | - Cyro Hirano
- Division of Dermatology General Polyclinic of Rio de Janeiro, Private Practice, CD Clinica Dermatologica, Rio de Janeiro, Brazil
| | - Marina Landau
- Dermatology Unit, Wolfson Medical Center, Holon, Israel
| | | | - Heather Woolery-Lloyd
- Department of Ethnic Skin Care, University of Miami Cosmetic Medicine and Research Institute, Miami Beach, FL, USA
| | | | - Je-Young Park
- Apkoo-Jung Department, Oracle Dermatology Center, Seoul, Republic of Korea
| | - Yana Yutskovskaya
- Dermatovenerology and Cosmetology Department, Pacific State Medical University of Health, Moscow, Russia
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Arroyo C. Fractional CO 2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Womens Health 2017; 9:591-595. [PMID: 28894392 PMCID: PMC5584900 DOI: 10.2147/ijwh.s136857] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study investigated a novel fractional carbon dioxide (CO2) laser for treatment of symptoms associated with vulvovaginal atrophy (VVA) in perimenopausal women. METHODS The study included 21 perimenopausal women (mean age 45±7 years) treated three times by CO2 laser resurfacing and coagulation of the vaginal canal tissue and mucosal tissue of the introitus. Vaginal health index (VHI) scores were computed by the investigator at baseline and follow-ups. Subjects reported on sexual function, satisfaction, and improvement with treatment. A visual analog scale was used to measure discomfort with treatment. RESULTS Vaginal health and subject assessment of vaginal symptoms improved with successive treatments. At 12 weeks following the third treatment, 82% of the patients showed a statistically significant improvement in VHI (P<0.05). Additionally, 81% of subjects reported improvement in sexual gratification, 94% reported improvement in vaginal rejuvenation, and 100% reported satisfaction with treatment. VHI improvement remained significant at 6-8 months after treatments (P<0.01). Most patients (97%) reported no to mild discomfort with treatment. Responses were mild and transient following treatment, with itching being the most commonly reported (20%) side effect. CONCLUSION In this study, fractional CO2 laser treatment was associated with improvement of vaginal health and amelioration of symptoms of VVA, resulting in improved sexual function in perimenopausal women. Treatment time was quick, and there was minimal discomfort associated with treatment. Investigation of clinical outcome in a larger study population is warranted.
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Affiliation(s)
- César Arroyo
- HM Montepríncipe University Hospital Laser Unit, Madrid, Spain
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McGoldrick RB, Theodorakopoulou E, Azzopardi EA, Murison M. Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars. Scars Burn Heal 2017; 3:2059513116689805. [PMID: 29799579 PMCID: PMC5965340 DOI: 10.1177/2059513116689805] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.
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Affiliation(s)
- Rory Boyd McGoldrick
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | - Evgenia Theodorakopoulou
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | | | - Maxwell Murison
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
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Husain Z, Alster TS. The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol 2016; 9:29-40. [PMID: 26893574 PMCID: PMC4745852 DOI: 10.2147/ccid.s69106] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.
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Affiliation(s)
- Zain Husain
- Department of Dermatology, Georgetown University Hospital, Washington, DC, USA
| | - Tina S Alster
- Department of Dermatology, Georgetown University Hospital, Washington, DC, USA; Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
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Abstract
This review has been withdrawn because a review author contravenes Cochrane's Commercial Sponsorship Policy. This policy ensures the independence of Cochrane reviews by making sure that there is no bias associated with commercial conflicts of interest in the conduct of Cochrane reviews. The author was employed by the biopharmaceutical company AstraZeneca and cannot say with certainty that the company did not produce or have any financial interest in the interventions in this review. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Miny Samuel
- Research Triangle Institute‐Health SolutionsWilliams House, Lloyd Street NorthManchester Science ParkManchesterUKM15 6SE
| | - Rebecca Brooke
- University of Nottinghamc/o Cochrane Skin GroupKing's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Sally Hollis
- University of Nottinghamc/o Cochrane Skin GroupKing's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Christopher EM Griffiths
- The University of Manchester, Salford Royal NHS Foundation TrustThe Dermatology CentreStott LaneSalfordManchesterUKM6 8HD
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Sebaratnam DF, Lim AC, Lowe PM, Goodman GJ, Bekhor P, Richards S. Lasers and laser-like devices: Part two. Australas J Dermatol 2013; 55:1-14. [DOI: 10.1111/ajd.12111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/11/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Deshan F Sebaratnam
- Department of Dermatology; Royal Prince Alfred Hospital; Camperdown New South Wales
- University of Sydney; Camperdown New South Wales
| | - Adrian C Lim
- Department of Dermatology; Royal North Shore Hospital; St Leonards New South Wales
| | - Patricia M Lowe
- Department of Dermatology; Royal Prince Alfred Hospital; Camperdown New South Wales
- University of Sydney; Camperdown New South Wales
| | | | - Philip Bekhor
- Department of Dermatology; Royal Childrens Hospital; Melbourne Victoria
| | - Shawn Richards
- Skin and Cancer Foundation Australia; Westmead New South Wales Australia
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Preissig J, Hamilton K, Markus R. Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface. Semin Plast Surg 2013; 26:109-16. [PMID: 23904818 DOI: 10.1055/s-0032-1329413] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Numerous laser platforms exist that rejuvenate the skin by resurfacing its upper layers. In varying degrees, these lasers improve the appearance of lentigines and rhytides, eliminate photoaging, soften scarring due to acne and other causes, and treat dyspigmentation. Five major classes of dermatologic lasers are currently in common use: ablative and nonablative lasers in both fractionated and unfractionated forms as well as radiofrequency technologies. The gentler nonablative lasers allow for quicker healing, whereas harsher ablative lasers tend to be more effective. Fractionating either laser distributes the effect, increasing the number of treatments but minimizing downtime and complications. In this review article, the authors seek to inform surgeons about the current laser platforms available, clarify the differences between them, and thereby facilitate the identification of the most appropriate laser for their practice.
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Affiliation(s)
- Jason Preissig
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
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10
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Fractional CO2 laser in the treatment of facial scars in children. Lasers Med Sci 2013; 29:855-7. [DOI: 10.1007/s10103-013-1305-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
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Hedelund L, Haak CS, Togsverd-Bo K, Bogh MK, Bjerring P, Haedersdal M. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation. Lasers Surg Med 2012; 44:447-52. [PMID: 22766970 DOI: 10.1002/lsm.22048] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND The treatment of acne scars with fractional CO(2) lasers is gaining increasing impact, but has so far not been compared side-by-side to untreated control skin. OBJECTIVE In a randomized controlled study to examine efficacy and adverse effects of fractional CO(2) laser resurfacing for atrophic acne scars compared to no treatment. METHODS Patients (n = 13) with atrophic acne scars in two intra-individual areas of similar sizes and appearances were randomized to (i) three monthly fractional CO(2) laser treatments (MedArt 610; 12-14 W, 48-56 mJ/pulse, 13% density) and (ii) no treatment. Blinded on-site evaluations were performed by three physicians on 10-point scales. Endpoints were change in scar texture and atrophy, adverse effects, and patient satisfaction. RESULTS Preoperatively, acne scars appeared with moderate to severe uneven texture (6.15 ± 1.23) and atrophy (5.72 ± 1.45) in both interventional and non-interventional control sites, P = 1. Postoperatively, lower scores of scar texture and atrophy were obtained at 1 month (scar texture 4.31 ± 1.33, P < 0.0001; atrophy 4.08 ± 1.38, P < 0.0001), at 3 months (scar texture 4.26 ± 1.97, P < 0.0001; atrophy 3.97 ± 2.08, P < 0.0001), and at 6 months (scar texture 3.89 ± 1.7, P < 0.0001; atrophy 3.56 ± 1.76, P < 0.0001). Patients were satisfied with treatments and evaluated scar texture to be mild or moderately improved. Adverse effects were minor. CONCLUSIONS In this single-blinded randomized controlled trial we demonstrated that moderate to severe atrophic acne scars can be safely improved by ablative fractional CO(2) laser resurfacing. The use of higher energy levels might have improved the results and possibly also induced significant adverse effects.
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Affiliation(s)
- Lene Hedelund
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
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13
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Tretti Clementoni M, Galimberti M, Tourlaki A, Catenacci M, Lavagno R, Bencini PL. Random fractional ultrapulsed CO2 resurfacing of photodamaged facial skin: long-term evaluation. Lasers Med Sci 2012; 28:643-50. [PMID: 22622960 DOI: 10.1007/s10103-012-1116-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
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 24 months 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 3 months after the procedure. Three months later all features, except for pigmentations, once again showed a significant statistical improvement. Results after 24 months were similar to those assessed 18 months 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 2 years after the procedure.
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Campolmi P, Bonan P, Cannarozzo G, Bassi A, Bruscino N, Arunachalam M, Troiano M, Lotti T, Moretti S. Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology. ScientificWorldJournal 2012; 2012:546528. [PMID: 22593693 PMCID: PMC3347966 DOI: 10.1100/2012/546528] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 01/04/2012] [Indexed: 12/01/2022] Open
Abstract
The CO2 laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO2 laser delivery system and the newer “superpulsed” and scanned CO2 systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO2 laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.
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Affiliation(s)
- Piero Campolmi
- Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Villa S.Chiara, Piazza Indipendenza 11, 50129 Florence, Italy
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Holcomb JD. Versatility of erbium YAG laser: from fractional skin rejuvenation to full-field skin resurfacing. Facial Plast Surg Clin North Am 2012; 19:261-73. [PMID: 21763988 DOI: 10.1016/j.fsc.2011.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
For the laser surgeon, the Er-YAG laser is an invaluable tool that delivers unsurpassed ablation efficiency, and with appropriate functionality (quasi long-pulse feature) provides sufficient tissue coagulation to remodel deep rhytids. As such, the 2940-nm wavelength is well suited for routine laser skin rejuvenation in full-field, fractional, and point-beam modes with additional benefits, including applicability to diverse skin types, short healing times, and a low likelihood of energy-related complications.
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Affiliation(s)
- J David Holcomb
- Holcomb Facial Plastic Surgery and Institute for Integrated Aesthetics, 1 South School Avenue, Suite 800, Sarasota, FL 34237, USA.
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Walgrave SE, Kist DA, Noyaner-Turley A, Zelickson BD. Minimally ablative resurfacing with the confluent 2,790 nm erbium:YSGG Laser: A pilot study on safety and efficacy. Lasers Surg Med 2012; 44:103-11. [DOI: 10.1002/lsm.21124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2011] [Indexed: 11/08/2022]
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A human skin explant model to study molecular changes in response to fractional photothermolysis: Spatio-temporal expression of HSP70. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mla.2009.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstracts from IMCAS, Paris, January 2002. J COSMET LASER THER 2009. [DOI: 10.1080/147641702321136273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fattahi T. S123: Clinical Application of CO2 Laser in Facial Esthetic Surgery. J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.joms.2008.05.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol 2008; 58:719-37; quiz 738-40. [PMID: 18423256 DOI: 10.1016/j.jaad.2008.01.003] [Citation(s) in RCA: 270] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED The drive to attain cosmetic facial enhancement with minimal risk and rapid recovery has inspired the field of nonsurgical skin rejuvenation. Laser resurfacing was introduced in the 1980s with continuous wave carbon dioxide (CO(2)) lasers; however, because of a high rate of side effects, including scarring, short-pulse, high-peak power, and rapidly scanned, focused-beam CO(2) lasers and normal-mode erbium-doped yttrium aluminium garnet lasers were developed, which remove skin in a precisely controlled manner. The prolonged 2-week recovery time and small but significant complication risk prompted the development of non-ablative and, more recently, fractional resurfacing in order to minimize risk and shorten recovery times. Nonablative resurfacing produces dermal thermal injury to improve rhytides and photodamage while preserving the epidermis. Fractional resurfacing thermally ablates microscopic columns of epidermal and dermal tissue in regularly spaced arrays over a fraction of the skin surface. This intermediate approach increases efficacy as compared to nonablative resurfacing, but with faster recovery as compared to ablative resurfacing. Neither nonablative nor fractional resurfacing produces results comparable to ablative laser skin resurfacing, but both have become much more popular than the latter because the risks of treatment are limited in the face of acceptable improvement. LEARNING OBJECTIVES At the completion of this learning activity, participants should be familiar with the spectrum of lasers and light technologies available for skin resurfacing, published studies of safety and efficacy, indications, methodologies, side effects, complications, and management.
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Fattahi T. S411. J Oral Maxillofac Surg 2006. [DOI: 10.1016/j.joms.2006.06.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Because of considerable morbidities and recovery time associated with CO2 laser resurfacing,many efforts are being made to discover a less ablative resurfacing modality. A thorough review of the literature demonstrates promising but less than ideal results for all of the currently used lasers. The clinical efficacy does not appear to be as significant as the histologic results that have been documented. Our review of the literature also demonstrates that not all of the modalities are equal.
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Affiliation(s)
- Edwin F Williams
- Section of Facial Plastic and Reconstructive Surgery, Division of Otolaryngology Head and Neck Surgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA.
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Affiliation(s)
- Suzanne L Kilmer
- Laser and Skin Surgery Center of Northern California, 3835 J Street, Sacramento, CA 95816, USA.
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Scheinfeld N, Yu T, Weinberg J, Gordon M, Silapunt S, Norman RA, Alam M. Cutaneous oncologic and cosmetic surgery in geriatric patients. Dermatol Clin 2004; 22:97-113. [PMID: 15018014 DOI: 10.1016/s0733-8635(03)00110-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A wide array of surgical procedures is available to geriatric patients. These interventions can enhance the appearance of patients and facilitate the removal of skin cancers. Pre-existing medical conditions of geriatric patients must be considered comprehensively when selecting and performing cutaneous surgical procedures. Many older patients suffer from a variety of diseases and take a variety of medications and herbal supplements to ameliorate the consequences of such diseases. In general, skin surgery can be performed safely on even very old patients, provided precautions are followed. The biopsychosocial well-being and essence of patients must also be addressed when performing dermatologic surgery. If patients are treated holistically and comprehensively, their surgical experience can be enhanced and their health and appearance improved.
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Affiliation(s)
- Noah Scheinfeld
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11-D, New York, NY 10025, USA
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Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49:1-31; quiz 31-4. [PMID: 12833005 DOI: 10.1067/mjd.2003.582] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.
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Affiliation(s)
- Elizabeth L Tanzi
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA
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Christian MM. Microresurfacing using the variable-pulse erbium:YAG laser: a comparison of the 0.5- and 4-ms pulse durations. Dermatol Surg 2003; 29:605-11. [PMID: 12786703 DOI: 10.1046/j.1524-4725.2003.29145.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Laser resurfacing has become less popular because of its long recovery time, significant discomfort, and potential risks. Microsurfacing employs the use of single-pass erbium:YAG (Er:YAG) "mini peels," which may be performed serially. OBJECTIVE The purpose of this study was to evaluate the efficacy and patient acceptance of microresurfacing Er:YAG peels in treating facial photodamage. The variable-pulse Er:YAG system was used and was allowed a comparison of the 0.5- and 4-ms pulse widths. METHODS Six female patients underwent eight microresurfacing peels in a split-face fashion using the 0.5- and 4.0-ms pulse durations of a variable-pulse Er:YAG laser. Patients returned at postoperative Days 3 to 4 and 7 for clinical evaluation and Mexameter measurements. RESULTS There were no significant differences in healing or postoperative erythema between the 0.5- and 4-ms pulse durations on postoperative Day 7. The average time to reepithelialization was 3.6 days. In a 1-year postoperative interview, four of six patients said that they would undergo the peel again periodically, and five of six stated they had maintained some level of improvement. CONCLUSION Microresurfacing is an effective and well-tolerated procedure. Benefits include its tolerability under topical anesthesia, limited down time, and high patient satisfaction.
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Affiliation(s)
- Mary M Christian
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Tanzi EL, Alster TS. Single-pass carbon dioxide versus multiple-pass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates. Dermatol Surg 2003; 29:80-4. [PMID: 12534517 DOI: 10.1046/j.1524-4725.2003.29012.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ablative laser skin resurfacing with carbon dioxide (CO2) and erbium:yttrium-aluminum-garnet (Er:YAG) lasers has been popularized in recent years and their side effects individually reported. No prior study, however, has directly compared the relative healing times and complications rates between the two different systems. OBJECTIVE To evaluate and compare postoperative wound healing and short- and long-term side effects of single-pass CO2 and multiple-pass, long-pulsed Er:YAG laser skin resurfacing for the treatment of facial photodamage and atrophic scars. METHODS A retrospective chart review and analysis of sequential clinical photographs were performed in 100 consecutive patients who underwent laser skin resurfacing with single-pass CO2 (Ultrapulse 5000; Coherent, Palo Alto, CA, N=50) or multiple-pass, long-pulsed Er:YAG laser resurfacing (Contour; Sciton, Palo Alto, CA, N=50). All laser procedures were performed by a single operator for the amelioration of facial rhytides or atrophic scars. The rate of re-epithelialization, duration of erythema, and presence of complications were tabulated. RESULTS The average time to re-epithelialization was 5.5 days with single-pass CO2 and 5.1 days with long-pulsed Er:YAG laser resurfacing. Postoperative erythema was observed in all patients, lasting an average of 4.5 weeks after single-pass CO2 laser treatment and 3.6 weeks after long-pulsed Er:YAG laser treatment. Hyperpigmentation was seen in 46% of the patients treated with single-pass CO2 and 42% of the patients treated with the long-pulsed Er:YAG laser (average duration of 12.7 and 11.4 weeks, respectively). No incidences of hypopigmentation or scarring were observed. CONCLUSION Skin resurfacing with single-pass CO2 or multiple-pass long-pulsed Er:YAG laser techniques yielded comparable postoperative healing times and complication profiles.
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Affiliation(s)
- Elizabeth L Tanzi
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA
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Weiss RA, Weiss MA, Beasley KL. Rejuvenation of photoaged skin: 5 years results with intense pulsed light of the face, neck, and chest. Dermatol Surg 2002; 28:1115-9. [PMID: 12472489 DOI: 10.1046/j.1524-4725.2002.02113.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Photorejuvenation involves the use of lasers or light sources to reverse signs of photoaging. Multiple devices have been shown to be effective over the short-term. OBJECTIVE To investigate the long-term clinical results on the face, neck and chest at 4 years using filtered flashlamp intense pulsed light (IPL) for treatment of photoaging changes of telangiectasias, dyspigmentation, and rough skin texture. METHODS A chart review of 80 randomly selected patients with skin types I-IV who were treated by IPL during 1996 and 1997 was performed. Photos and patient self-assessment were graded for features of textural smoothness, telangiectasia severity, and blotchy pigmentation into four categories of worse, no change, slightly better (less than 50% improvement) and much better (greater than 50% improvement). RESULTS At 4 years following initial treatment, skin textural improvement was noted in 83% of the subjects. Telangiectasias were improved in 82% of subjects, while pigmentation remained improved in 79%. The median number of treatments was 3. The face responded slightly better than the chest or neck. Most common side-effects included temporary mild crusting (19%), erythema (15%) and purpura (6%). CONCLUSION Signs of photoaging including telangiectasias and mottled pigmentation of the face, neck, and chest, can be improved by IPL with a long-lasting result. Minimal or no downtime with minimal adverse effects can be achieved with the settings reported. Skin textural smoothing, although not easily quantified, is an additional benefit observed long-term.
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Affiliation(s)
- Robert A Weiss
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Affiliation(s)
- Prost Anne Le Pillouer
- Department of Plastic and Reconstructive Surgery, Hôpital de la Conception, Marseilles, France
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