Assessment of the Efficacy of Nonablative Long-Pulsed 1064-nm Nd:YAG Laser Treatment of Wrinkles Compared at 2, 4, and 6 Months

A Long-Term Follow-up Study for the Treatment of Snoring after Using Patterned Non-Ablative Erbium: YAG 2,940 nm Laser

Introduction  Laser uvulopalatoplasty is an established operation for the treatment of snoring with good results on a short-term basis, while long-term follow-up studies, in addition to their scarcity, had conflicting results regarding recurrence, the change of snoring quality, and complications. Objective  To assess the long-term follow-up results of using nonablative 2,940 nm Erbium: YAG for the treatment of snoring regarding outcomes and recurrence. Methods  This 2-year follow-up study was conducted on 76 patients operated upon by non-ablative 2940 nm Erbium: yttrium-aluminum-garnet (YAG) using a PS01 patterned headpiece. Subjective evaluation of the treatment was performed relying on a smartphone application to record snoring in addition to a questionnaire specially designed to report recurrence and change in the quality of snoring reported by a patient's spouse. The objective evaluation was done by computed tomography (CT) imaging of the soft palate. The patients were evaluated preoperatively, 6 weeks postoperatively and after a 2-year follow-up period. Results  Six week after the procedure, there was a significant improvement in 52 patients (68.4%). Out of the 52 patients, only 43 completed the 2-year follow-up; however, 15 of them complained of recurrence. Nevertheless, the patients who suffered from recurrence showed subjective improvement in snoring quality. Conclusions  The nonablative mode of Erbium: YAG 2,940 nm laser proved to be efficient in soft palate tightening for the management of snoring. However, there was recurrence in 34.8% of the patients who presented objective and subjective improvement of the complaints, 6 weeks postoperatively and after a 2-year follow-up period.

Histological and immunohistochemical changes in facial skin treated with combined ablative and non-ablative laser therapy

Background

Facial skin rejuvenation is a highly sought after procedure. Different materials, energy‐based devices and techniques have been shown to offer good results in facial rejuvenation.

Aims

The aim of this study was to evaluate the macroscopic and histological and immunohistochemical changes in facial skin treated with a combined laser therapy.

Patients/Methods

Fourteen patients aged from 38 to 59 years were included in the study. Two different wavelengths (2940 and 1064 nm) were used in this four‐step procedure.

Results

Significant improvement according to classification for age‐related changes in all areas of the face was achieved. There were also significant structural changes in the epidermis and dermis, confirmed with histology and immunohistochemistry.

Conclusion

The dual‐wavelength protocol has been found to provide excellent results for facial rejuvenation.

Split-face comparison of grid fractional radiofrequency vs 1064-nm Nd-YAG laser treatment of periorbital rhytides among Filipino patients

Despite multiple individual studies proving efficacy of grid fractional monopolar radiofrequency (Grid RF) and near-infrared irradiation 1064-nm long-pulsed neodymium:YAG laser (Laser Genesis), there is a lack of controlled comparative trials between these devices. This study aims to compare the efficacy and safety of Grid RF versus Laser Genesis in the treatment of periorbital rhytides. This is a randomized, single-blind, split-face, prospective study. Eight patients with moderate to severe periorbital rhytides were treated with either Grid RF or Laser Genesis on each side of the face. Photographic and live assessment with the Lemperle Wrinkle Assessment grading scale was compared after 2 months. Difference in scores between Grid RF vs Laser genesis groups after 2 months was not statistically significant (P = 0.244). Each group showed statistically significant improvement months post-procedure (P < .05). Immediate adverse effects and satisfaction scale were similar for both groups (P > .05). At 2 months follow-up, no adverse effects were seen. Grid monopolar radiofrequency (Grid RF) vs near-infrared radiation 1064 nm long-pulsed Nd-YAG laser (Laser Genesis) were equally efficacious, safe, and well-tolerated among patients in the treatment of periorbital wrinkles (P > .05).

Broadband light treatment using static operation and constant motion techniques for skin tightening in Asian patients

BACKGROUND

Broadband light (BBL) devices irradiate photons of different wavelength to induce photothermal reactions on various aging-related chromophores.

OBJECTIVES

To evaluate three BBL treatment settings for skin tightening in Asian patients.

METHODS

A total of 27 patients underwent three sessions of BBL treatment via (1) an 800-nm cutoff filter using a static operation technique and a 695-nm cutoff filter using a constant motion technique (group 1, N = 9), (2) an 800-nm cutoff filter using a constant motion technique (group 2, N = 9), and (3) a 590-nm cutoff filter using a constant motion technique (group 3, N = 9).

RESULTS

The patients in group 1 presented marked clinical improvements in zygomatic wrinkles, nasolabial folds, and marionette lines, with a median overall global aesthetic improvement scale (GAIS) score of 3. Meanwhile, patients in group 2 exhibited noticeable improvements in zygomatic wrinkles, nasolabial folds, perioral expression wrinkles at the cheek, and marionette lines, with a median GAIS score of 3. Patients in group 3 experienced improvement in skin tone and texture, zygomatic wrinkles, nasolabial folds, and marionette lines, with a median GAIS score of 2.

CONCLUSIONS

Our data demonstrated that BBL treatment for nonablative, noninvasive skin tightening elicits satisfactory clinical outcomes.

Efficacy of long pulse Nd:YAG laser versus fractional Er:YAG laser in the treatment of hand wrinkles

There are different modalities for hand rejuvenation. Fractional Er:YAG laser and long pulse Nd:YAG laser were introduced for treating hand wrinkles. We plan to compare fractional Er:YAG laser and long pulse Nd:YAG laser in a randomized controlled double-blind design with multiple sessions and larger sample size in comparison with previous studies. Thirty-three participants with hand wrinkles entered this study. They were randomly allocated to undergo three monthly laser treatments on each hand, one with a fractional Er:YAG laser and the other with a long pulse Nd:YAG laser. The evaluations included assessment of clinical improvement determined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of hands using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT). Moreover, potential side effects and patients' satisfaction have been documented at baseline, 1 month after each treatment, and 3 months after the final treatment session. Clinical evaluation revealed both modalities significantly reduce hand wrinkles (p value < 0.05), with no significant difference between two lasers. Mean CRRT values also decreased significantly after the laser treatment compared to those of the baseline in both laser groups. There was no serious persistent side effect after both laser treatments. Both fractional Er:YAG and long pulse Nd:YAG lasers show substantial clinical improvement of hand skin wrinkles with no serious side effects. However, combination treatment by these lasers along with the other modalities such as fat transfer could lead to better outcomes in hand rejuvenation.

TRIAL REGISTRATION

IRCT2016032020468N4.

Split face evaluation of long-pulsed non-ablative 1,064 nm Nd:YAG laser for treatment of direct browplasty scars

PURPOSE

To investigate 1,064 nm long-pulse Nd:YAG laser for postoperative treatment of direct browplasty scars.

METHODS

Nine patients who underwent direct browplasty were enrolled in this prospective study. Subjects were randomized to unilateral laser treatment at 2-week intervals for six total treatments, with the contralateral scar used as a control. Prior to each treatment, subjects rated treated and control scars on overall cosmesis. Post-treatment, subjects rated each for erythema, swelling, discomfort, and perceived hair loss. Finally, examiners masked to treatment side were asked to judge side-by-side photographs of first and final visits for improvement and side effects.

RESULTS

Subjects rated the overall appearance of the treated scar significantly higher at the time of treatment number 5 (mean score 5.13 ± 2.03, P = 0.008) and treatment number 6 (6.25 ± 1.98, P = 0.005) compared to treatment 1 (3.75 ± 2.12); by contrast, they failed to rate the control scar more highly. On masked examination of photographs, the treated scar was selected as most improved 50.0 ± 12.5% of the time. Both subjects and graders reported side effects as transient and mild to moderate (mean score 1-4), with no reports of hair loss from either subjects or observers.

CONCLUSIONS

The 1,064 nm Nd:YAG laser provided significant improvement in scar cosmesis after direct browplasty, as rated by subject self-report, but not by masked observers, and appears to be a useful tool for increasing satisfaction among those dissatisfied with direct browplasty scars. Side effects-including erythema, edema, and discomfort-were transient and universally rated as mild to moderate. Lasers Surg. Med. 48:742-747, 2016. © 2016 Wiley Periodicals, Inc.

Comparison of effectiveness of 1,064-nm Nd:YAG laser and Nd:YAG laser-IPL combination treatments in hand skin rejuvenation

OBJECTIVE

Evaluation of the efficacy and side effects of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and Nd:YAG laser-intense pulsed light (IPL) combination treatments in photorejuvenations of skin of the hand, and determining their impacts on patient satisfaction.

MATERIALS AND METHODS

Thirty-five female patients with signs of photoaging on the skin of their hands were included in the study. Three sessions of IPL and four sessions of Nd:YAG laser treatment were applied to the right hand in total with 2-week intervals between each session, whereas six sessions of Nd:YAG laser treatment were applied to the left hand of patients with 2-week intervals between each session.

RESULTS

The patients' ages ranged between 31 and 78, and mean age was 60.77 ± 9.48. While there was no difference in pigment distribution, fine wrinkles, coarse wrinkles, and global scores between the right and left hand prior to treatment (p > 0.05), average pigment tone score was higher in the right hand with a statistically significant difference (p < 0.05). There was greater improvement in scores of pigment distribution, fine wrinkles, sallowness, pigment tone parameters, and global score on the right hand compared to left hand, which was statistically significant (p <0.001).

CONCLUSION

In rejuvenation of photoaged dorsal skin of the hand, IPL-Nd:YAG laser combination treatment surpasses Nd:YAG laser treatment.

Comparison of epidermal/dermal damage between the long-pulsed 1064 nm Nd:YAG and 755 nm alexandrite lasers under relatively high fluence conditions: quantitative and histological assessments

OBJECTIVE

The purpose of this study was to compare degrees of epidermal/dermal tissue damage quantitatively and histologically after laser irradiation, to find ideal treatment conditions with relatively high fluence for skin rejuvenation.

BACKGROUND DATA

A number of recent studies have evaluated the clinical efficacy and safety of therapeutic lasers under relatively low fluence conditions.

METHODS

We transmitted the long-pulsed 1064 nm Nd:YAG and 755 nm Alexandrite lasers into pig skin according to different fluences and spot diameters, and estimated epidermal/dermal temperatures. Pig skin specimens were stained with hematoxylin and eosin for histological assessments. The fluence conditions comprised 26, 30, and 36 J/cm2, and the spot diameter conditions were 5, 8, and 10 mm. Pulse duration was 30 ms for all experiments.

RESULTS

Both lasers produced reliable thermal damage on the dermis without any serious epidermal injuries, under relatively high fluence conditions. The 1064 nm laser provided more active fibrous formations than the 755 nm laser, while higher risks for tissue damages simultaneously occurred.

CONCLUSIONS

The ideal treatment conditions for skin rejuvenation were 8 mm diameter with 30 J/cm2 and 10 mm diameter with 26 J/cm2 for the 1064 nm laser, and 8 mm diameter with 36 J/cm2 and 10 mm diameter with 26 J/cm2 for the 755 nm laser.

[Therapeutic approaches for the treatment of facial aging]

Over the last few decades, a magnitude of novel therapeutic approaches to battle the signs of facial aging have become available in esthetic dermatology. Comprehensive research in this area has significantly improved our understanding of the anatomy and physiology of facial aging. In order to successfully address age-related alterations in the human face, today's anti-aging treatment frequently necessitates multifaceted options. Alongside botulinum toxin and fillers, a plethora of different modalities are currently available to complete our esthetic portfolio, which are discussed in this review.

Cellulite: an evidence-based review

BACKGROUND

Cellulite is a multifactorial condition that is present in 80-90 % of post-pubertal women. Despite its high prevalence, it remains a major cosmetic concern for women. A wide range of products and treatments for cellulite reduction is available; however, no systematic review has been performed so far to evaluate the efficacy of the available treatment options for cellulite.

OBJECTIVE

The objective of this review is to provide a systematic evaluation of the scientific evidence of the efficacy of treatments for cellulite reduction.

METHODS

This systematic review followed the PRISMA guidelines for reporting systematic reviews and meta-analyses. Only original articles in English or German reporting data on the efficacy of cellulite treatments from in vivo human studies were considered. In total, 67 articles were analyzed for the following information: therapy, presence of a control group, randomization, blinding, sample size, description of statistical methods, results, and level of evidence.

RESULTS

Most of the evaluated studies, including laser- and light-based modalities, radiofrequency, and others had important methodological flaws; some did not use cellulite severity as an endpoint or did not provide sufficient statistical analyses. Of the 67 studies analyzed in this review, only 19 were placebo-controlled studies with randomization. Some evidence for potential benefit was only seen for acoustic wave therapy (AWT) and the 1440 nm Nd:YAG minimally invasive laser.

CONCLUSION

This article provides a systematic evaluation of the scientific evidence of the efficacy of treatment for cellulite reduction. No clear evidence of good efficacy could be identified in any of the evaluated cellulite treatments.

A novel approach to structural facial volume replacement

Improved understanding of the anatomy and physiology of the aging face has laid the foundation for adopting an earlier and more comprehensive approach to facial rejuvenation, shifting the focus from individual wrinkle treatment and lift procedures to a holistic paradigm that considers the entire face and its structural framework. This article presents an overview of a comprehensive method to address facial aging. The key components to the reported strategy for improving facial cosmesis include, in addition to augmentation of volume loss, protection with sunscreens and antioxidants; promotion of epidermal cell turnover with techniques such as superficial chemical peels; microlaser peels and microdermabrasion; collagen stimulation and remodeling via light, ultrasound, or radiofrequency (RF)-based methods; and muscle control with botulinum toxin. For the treatment of wrinkles and for the augmentation of pan-facial dermal lipoatrophy, several types of fillers and volumizers including hyaluronic acid (HA), autologous fat, and calcium hydroxylapatite (CaHA) or injectable poly-L-lactic acid (PLLA) are available. A novel bimodal, trivector technique to restore structural facial volume loss that combines supraperiosteal depot injections of volume-depleted fat pads and dermal/subcutaneous injections for panfacial lipoatrophy with PLLA is presented. The combination of treatments with fillers; toxins; light-, sound-, and RF-based technologies; and surgical procedures may help to forestall the facial aging process and provide more natural results than are possible with any of these techniques alone.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Striae distensae after breast augmentation

BACKGROUND

One known but not fully understood complication after breast augmentation is the new onset of stretch marks (striae distensae) on the surgically treated breast. To date, all publications on this subject have been case reports. No report has fully described the actual incidence, risk factors, or management of striae distensae after breast surgery.

METHODS

This study prospectively followed patients who underwent primary breast augmentation using silicone implants in a single group practice from 2007 to 2011. New-onset striae distensae were actively investigated. Time from surgery to the moment of striae onset, patient age, nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and other variables were evaluated.

RESULTS

A total of 409 patients were included in the study. In 19 cases (4.6%), new-onset striae distensae after breast augmentation were observed. The population with striae distensae was significantly younger than the total population (29.56 vs 20.91 years; p=0.012). Striae distensae also were more common in nulliparous than in multiparous women (8.29 vs 0.52%; p=0.006), overweight women (17.77 vs 3.02%; p=0.016), women using oral contraceptives (7.89 vs 0.55%; p=0.008), and women with a personal history of stretch marks (8.97 vs 3.36%; p=0.031). No relation was shown regarding implant pocket type, size, or profile.

CONCLUSION

Striae distensae may be a common but underreported complication after breast augmentation. In this series, striae distensae developed in 4.6% of the patients within 1 year after breast augmentation. Severity may vary from inconspicuous small marks (classifications 1 and 2) to wide red and active striae rubra (classifications 3 and 4). Nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and younger age were related to a higher incidence of striae distensae. The increased rates in these groups may be associated with their exposure to higher estrogen levels and the important role of this hormone in facilitating the formation of striae distensae. Further studies are needed to show whether changes in these risk factors (i.e., weight loss, contraceptive withdrawal) may help to decrease striae distensae rates is these populations.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Effects of long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet laser on dermal collagen remodeling in hairless mice

BACKGROUND

Nonablative lasers are used for dermal collagen remodeling. Although clinical improvements have been reported using various laser devices, the mechanism of dermal collagen remodeling remains unknown.

OBJECTIVE

To investigate the effects of energy fluences of the long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) nonablative laser on dermal collagen remodeling and evaluate the dermal collagen remodeling mechanism.

MATERIALS AND METHODS

Hairless mice were pretreated with ultraviolet B irradiation to produce photo-damage. The laser treatment used a long-pulse 1,064-nm Nd:YAG laser at energy fluences of 20, 40, and 60 J/cm(2) . The amount of dermal collagen and expressions of transforming growth factor beta (TGF-β), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) of laser treated skin were compared with those of nontreated control skin.

RESULTS

The long-pulse Nd:YAG laser treatment increased dermal collagen and significantly increased TGF-β expression. The expression of MMP-1 decreased with low energy fluence. The expression of TIMP-1 was not significantly different.

CONCLUSION

Long-pulsed 1,064-nm Nd:YAG laser increases the dermal collagen in association with the increased expression of TGF-β.

Effects of the Nd:YAG 1320-nm laser on skin rejuvenation: clinical and histological correlations

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is a popular non-ablative treatment used for skin rejuvenation. The purpose of this prospective study was to evaluate the clinical effects, coupled with a quantitative assessment, of the histological changes in response to Nd:YAG 1320-nm laser treatment of periocular wrinkles. Six volunteers with Fitzpatrick skin types III and IV and Glogau class I-II wrinkles were subjected to 3 months of Nd:YAG 1320-nm treatment in the periocular area (six sessions at 2-week intervals). Volunteers were photographed, and skin biopsies were obtained at baseline as well as 3 and 6 months after the start of treatments. Quantitative evaluation of total elastin, newly synthesized tropoelastin, collagen types I, III and VII, and newly synthesized collagen was performed using a computerized morphometric analysis. A noticeable clinical and histological improvement was observed after Nd:YAG 1320-nm treatment. Collagen types I, III and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased after treatment. Our data suggest that Nd:YAG 1320 nm is an effective treatment for skin rejuvenation as it stimulates the repair processes, and reverses the clinical, as well as the histopathological, signs of skin aging.

Objective assessment of skin rejuvenation using near-infrared 1064-nm neodymium: YAG laser in Asians

BACKGROUND

We reported previously that near-infrared (NIR) irradiation provides long-lasting stimulation of elastin, and is efficient for skin rejuvenation. Many studies have indicated the efficacy of various types of laser, but did not include sufficiently objective evaluation. Therefore, we evaluated the efficacy of NIR laser treatment not only subjectively but also objectively.

METHODS

Fifty Japanese patients were treated with a NIR 1064-nm neodymium: YAG laser. Objective computer assessments were performed by Canfield VISIA Complexion Analysis for improvement of dilated pores, skin texture, and wrinkles. The volunteers then provided subjective assessments. Histological evaluations of elastin were performed by Victoria blue staining up to 90 days post-treatment in four Japanese volunteers.

RESULTS

Mean pretreatment percentiles of dilated pores, skin texture, and wrinkles were 51.08 ± 24.82, 54.7 ± 26.33, and 58.02 ± 28.61, respectively. Mean post-treatment percentiles of dilated pores, skin texture, and wrinkles were 53.58 ± 23.89, 58.58 ± 24.44, and 62.2 ± 25.39, respectively. All objective computer assessments evaluated by percentiles in dilated pores, skin texture, and wrinkles showed significant improvement after NIR laser treatment. Ninety-six percent, 100%, and 98% of volunteers reported satisfaction with the improvement of dilated pores, skin texture, and wrinkles, respectively. NIR laser treatment appeared to increase the amount of elastin at day 30, which then decreased slightly but was still elevated at day 90 compared with nonirradiated controls on day 0. Thickening of the epidermis was detected on day 30, and epidermal smoothness persisted for up to 90 days. No treatment-related adverse events were observed.

CONCLUSIONS

NIR irradiation increased elastin in the dermis, and achieved skin rejuvenation. The results indicated that NIR irradiation provides safe and effective long-term stimulation of elastin, which is beneficial for improving dilated pores, skin texture, and wrinkles.

Photodamage therapy using an electro-optic Q-switched Nd:YAG laser

BACKGROUND AND OBJECTIVE

Q-Switched Nd:YAG lasers produce photoacoustic effects in addition to photothermal effects which may allow for greater tissue collagen production. The objective of the study is to determine the effectiveness and tolerability of an Electro-Optic (EO) Q-switched Nd:YAG laser with Single Pulse and novel Double Pulse (DP) options in the treatment of photodamaged skin.

MATERIALS AND METHODS

Sixteen subjects with photoaging were enrolled in this prospective, randomized, split-faced study. Subjects received 6 bi-weekly laser treatments. One half of the face was treated with a Single Pulse while the other half was treated with energies divided into a DP. Blinded investigators and subjects assessed improvement after the sixth treatment for wrinkles, coarseness, pigmentation, redness, laxity, comedones, pore size, and overall skin condition. Subjects also rated the tolerability of the treatments.

RESULTS

For the Single Pulse side of the face, the investigators rated 33% of the patients as having a good to excellent (51% or greater) improvement in the overall condition of the skin while 47% of the subjects reported these levels. On the DP side, the overall improvement was good to excellent at a 27% rate by the investigators and 54% by the subjects. Distributions of improved ratings among investigators and subjects were similar for both sides of the treatment area. The majority of stinging/burning sensations during treatment were reported as mild on the DP side (62.8%) and moderate (63.8%) on the Single Pulse side. The chance of reporting none or only mild stinging/burning sensation during treatment was four times greater on the side of the face treated with the DP (P < 0.0001).

CONCLUSIONS

Results have shown that treatment with the EO QS Nd:YAG laser provides a safe and effective method of skin rejuvenation with the additional benefit of significantly lower patient discomfort during use of the DP mode.

Striae distensae (stretch marks) and different modalities of therapy: an update

BACKGROUND

Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment.

OBJECTIVE

To identify the current treatment modalities and their effectiveness in the treatment of stretch marks.

MATERIALS AND METHODS

Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications.

RESULTS

No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging.

CONCLUSION

The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies.

Laser induced collagen remodeling: a comparative study in vivo on mouse model

BACKGROUND AND OBJECTIVE

Many lasers have claimed the clinical efficacy on skin rejuvenation. In this study, the mechanisms of laser induced collagen remodeling were explored systematically on a Kunming (KM) mouse model in vivo by comparing the different non-ablative laser effects using four different laser treatment modalities.

MATERIALS AND METHODS

The dorsal skin of KM mice was exposed by depilation before the laser treatments. Four laser treatment modalities were used: the 595-nm pulsed dye laser (PDL) (10 ms), 1,320-nm neodymium-yttrium-aluminum garnet (Nd:YAG) laser (0.35 ms), 1,064-nm Nd:YAG laser with Q-switched (5 ns), and long-pulsed (0.3 ms) mode. Each modality exposed one side of the mouse dorsal skin leaving the other side as the contralateral control. Then skin histology, fibroblast number, and the genesis of collagen type I and III were studied by comparing the treatment site and control site at 1 hour, 1 day, 1 week, 3 weeks, 4 weeks, and 8 weeks after laser treatment. Hydroxyproline content of the skin tissue was measured 4 weeks and 8 weeks after laser exposure.

RESULTS

All laser treatments led to marked improvements in dermal layer thickness and collagen fiber density, and the increase in fibroblast number and hydroxyproline content compared with their own controls. Collagen synthesis and remodeling induced by the Q-switched 1,064-nm laser was most effective 4 weeks after treatment, while there was no significant difference among the other three modalities. Among the new collagen genesis after the different laser treatments, collagen type III increased sharply after the Q-switched 1,064-nm laser treatment whereas more collagen type I was elicited by the other laser treatment modalities.

CONCLUSIONS

The efficacy of photo-mechanical effects in promoting more effectively the synthesis of collagen type III, whereas the photo-thermal effect favored more the formation of collagen type I.

Cutaneous photoaging treated with a combined 595/1064 nm laser

BACKGROUND AND OBJECTIVES

The pulsed dye laser (PDL) has been used for a variety of vascular changes associated with photoaging. The Nd:YAG laser has been shown to be effective in the treatment of deeper facial vessels, as well as to stimulate new dermal collagen deposition. This study was undertaken to evaluate the safety and efficacy of sequential dual-wavelength PDL and Nd:YAG laser treatment of photoaged facial skin.

METHODS

Fifteen individuals, between the ages of 38 and 66 years old, with various stigmata of facial photoaging, were entered into the study. Five sequential combined PDL/Nd:YAG (Cynergy, Cynosure Inc., Westford, MA, USA) treatments were performed using a 10-mm handpiece at monthly intervals. PDL parameters included a 10-ms pulse duration and a fluence set at 1 J/cm2 below the purpura threshold. Nd:YAG parameters were set at a 50-ms pulse duration with fluences varying between 35 and 50 J/cm2, depending on patient comfort. Improvement was determined by evaluation of photographs taken before the first treatment and at 1 and 3 months following the last treatment, as well as the individual's self-assessment.

RESULTS

Individuals tolerated treatments well with no serious, long-term, or permanent adverse effects. Improvement was most pronounced in telangiectasias and diffuse erythema, followed by epidermal dyspigmentation and lentigines. Some individuals were also noted to have improved smoothness, radiance, or pore size. The improvement was generally maintained at the 3-month follow-up. In addition, the average self-reported improvement was 1.7 (on a 0-4 scale) at 1 month and 2.4 at 3 months following the last treatment.

CONCLUSION

A novel combined sequential PDL/Nd:YAG laser can be used to treat a variety of cutaneous changes associated with photoaging. Further studies may determine the relative impact of each laser and whether the total effect is simply additive or synergistic