Josepa Rigau

The origin and role of erythema after carbon dioxide laser resurfacing. A clinical and histological study.

background. Transient erythema, which can last up to 3 months after carbon dioxide (CO2) laser skin resurfacing, is a usual side effect with pulsed or rapidly scanned CO2 lasers. objective. We evaluated the cause of erythema in the clinical setting and by histology in order to determine if and how we may decrease it, or even eliminate it. methods. Ten patients who underwent resurfacing were recruited to this study. Skin punch biopsies were taken at 0, 7, 21, and 90 days and analyzed by light microscopy. results. Erythema was noticed from about day 8, when the crusting on the skin surface was exfoliated. It reached its maximum intensity after 14 days, and had disappeared by 60–90 days. Histology showed an early inflammatory response, with an immature neoepithelium, and rich vascularization. The normal epidermis had returned by 90 days, and during this period there was reduced optical scattering and absorption in melanin. conclusion. Although the erythema is an unwanted side effect in the patients eyes, it is to be expected and thus represents the effects of a combination of epidermal immaturity, reduced melanin absorption of light, reduced dermal optical scattering, and increased blood flow secondary to the surgically induced inflammatory response.

A clinical and histological comparison of flashscanning versus pulsed technology in carbon dioxide laser facial skin resurfacing.

background. Two different carbon dioxide (CO2) laser systems are currently in use for skin resurfacing. The vast majority of lasers use a pulsed beam, like the Coherent 5000C, but Shar‐plan uses scanning technology. objective. We describe a clinical and histological comparison of these two laser technologies in order to determine if there are differences in the outcome. methods. Twenty‐two female patients underwent facial skin resurfacing using the Coherent 5000C UltraPulse CPG on one side of the face and the Sharplan Silk Touch on the contralateral side of the face. The clinical appearances were assessed periodically after treatment and punch biopsies were taken preoperatively and after 7, 21, and 90 days. Tissue was stained with Hematoxylin‐Eosin, Masson Trichrom, and with the Verhoeff technique. Histological evaluation was performed on randomized samples taken from the same patient. Epidermis/dermis expression, collagen compaction, and elastin fiber quantity were compared to evaluate if any differences existed. results. The side treated by Coherent healed more rapidly and with excellent cosmesis. Greater erythema was observed on the Sharplan side, but had disappeared at the 90‐day evaluation. At this time the quality of the results was similar with no particular difference between the sides treated by the Coherent or the Sharplan lasers. At the histological level, although tissue recovered faster on the Coherent side at the 7‐day control, at 90 days the collagen was better compacted and organized on the Sharplan side. Similarly, the quantity of the elastin was significantly more enhanced on the Sharplan side. conclusion. Irradiated laser energy density in relation to time, and the way that it is delivered, should play an important role at the moment of producing collagen shrinkage. The SilkTouch delivers laser energy more aggressively, thereby producing a more intense inflammatory tissue reaction, which results in slower recovery of tissue, compared with the Coherent CPG. More active enhancement of vascularization found in the Sharplan is likely to be the reason for a more effective collagen proliferation and compaction. These changes, together with the increase in elastin in the dermis, may produce longer lasting effects in skin resurfacing.

Electron microscopy comparison of CO2 laser flash scanning and pulse technology one year after skin resurfacing

Background The recent adaptation of laser technology in plastic and dermatologic surgery has provided a means to reduce efficiently the irregularities of the surface of the skin. Previous studies have analyzed the short‐ and medium‐term clinical and histologic results of two laser systems: the Sharplan 40C SilkTouchTM and the 5000C Coherent Ultrapulse® with Computer Pattern Generator® (CPG). This paper contains the long‐term ultrastructural findings observed with the aid of transmission electron microscopy (TEM).

Pulsed and scanned carbon dioxide laser resurfacing 2 years after treatment: comparison by means of scanning electron microscopy.

Studies have reported short-term and long-term (1-year) findings for laser skin resurfacing. Two of the most popular systems used for this procedure, the continuous-wave Sharplan 40C SilkTouch system and the pulsed Coherent 5000C UltraPulse system with a computer pattern generator, were previously compared for a range of follow-up times up to 1 year, using light microscopy and transmission electron microscopy. This study analyzed the 2-year morphological differences using scanning electron microscopy. Tissue samples were obtained from 10 patients (age range, 50 to 72 years; skin types II and III) who had undergone laser resurfacing 2 years previously. One half of the face of each patient had been treated with the continuous-wave system and the other half with the pulsed system. The samples were subjected to scanning electron microscopy. On the continuous-wave-treated side, significantly better dermal collagen organization was observed at 2 years, with plump-appearing fibers that were closely knit to form a compact structure. On the side treated with the pulsed system, the collagen fibers in the papillary dermis were more loosely arranged and appeared drier. In both the continuous-wave-treated and pulsed-treated areas, the epidermis appeared healthy and exhibited some signs of age-related deterioration, with slightly flatter plaques and somewhat more flaking keratin on the pulsed-treated side. Probably because of the greater degree of residual thermal damage associated with the continuous-wave system, at 2 years after treatment there was more prolific synthesis and better orientation of collagen fibers, which were maintained for longer times, compared with the pulsed-treated specimens.

Effects of the 633-nm laser on the behavior and morphology of primary fibroblast culture

We previously described the influence of low-level laser therapy (LLLT) on the primary fibroblast ATCC CRL1471 CCD-19SK passage 7 in culture, metabolic changes and statistical significance absorption of 3[H]Hydroxyproline after 2 irradiations (12 hour intervals) with Ar:DYE Laser, 633 nm wavelength, output power 38 mw, spot size 3.5 cm, power density 4 mw/cm2, energy density plus or minus 2 J/cm2. The aim of this work is to investigate, by using the same procedure, the behavior of the confluence monolayer fibroblasts culture when a central scratch of 0.4 - 1 mm and 2 irradiations is performed, by means of the study of the colony formation, haptotaxis (direction) and chemotaxis- chemokinesis (movement). The results indicate that all these phenomena appear sooner in the LLLT cultures than in non-treated cultures. Thus we can confirm that LLLT induces fibroblast biological effects.

The filtrum remodelling with combined Er:YAG CO 2 laser resurfacing

BACKGROUND Upper lip wrinkles develop with aging and they can be successfully treated with laser resurfacing. The treatment eliminates the wrinkles and, ideally, should also recover the aesthetic configuration. METHODS This report includes 32 patients treated for wrinkles of the upper lip with the Derma K. The first pass was done using 29 J/cm2, 5 Hz, 3 mm collimated spot size, plus the CO2 laser 5 W, 50% duty cycle, 50% overlapping. Following this pass, Derma K was reprogrammed to emit only with the Er:YAG at 1.4 J/cm2, 10 Hz, approximately 50% overlapping and with a beam diameter of 3 mm. Then, several passes were done where wrinkles could still be seen, focusing on the area corresponding to the filtrum. Biopsies were taken to examine possible particular implications of underlying muscle and its role in the recovery of anatomic aesthetics of young lip characteristics when using the proposed technique. RESULTS Using Derma K resurfacing with extra passes of the Er:YAG at relatively low density, at the aforementioned area, it was possible to achieve the recovery of the aesthetic youthful appearance of the upper lip. Also, the shape of the filtrum recovered its youthful appearance together with the cupids bow shape. Histology samples collected at the end of resurfacing showed that the laser thermal effect was also related to muscle fibres due to the proximity of this layer to the dermis because of the narrow subcutaneous fat layer. CONCLUSION The combination of Er:YAG and CO2 laser of Derma K has potential to enhance the results of resurfacing for elimination of wrinkles of the upper lip. Moreover, the fact that only one laser pass of high energy density is used permits clear and secure control of treatment, preventing complications and obtaining good results.

The search for a youthful upper lip via laser resurfacing.

Generally, the upper lip resembles a bow of harmonious shape, characteristic of youthfulness. At the lip, noticeable wrinkles develop with aging, and these wrinkles can be successfully treated with laser resurfacing. Ideally, the aim of the treatment should include not only the wrinkles but the recovery of the whole aesthetic configuration of the upper lip. The study includes 236 patients treated for wrinkles of the upper lip either with the Coherent 5000C pulsed CO2 technology (300 mJ, density 6) or with the Flashscanning continuous wave emission, also CO2 technology (Sharplan FeatherTouch 36 W). Once resurfacing was done, passing the laser three times over the whole surface to recover the upper lip from the aging appearance of wrinkles, three more passes (same laser parameters) were performed at the area of the philtrum to reshape the Cupid’s bow. Biopsies were taken to examine possible particular implications of tissue behavior and the role in the recovery of the anatomy and aesthetics of young lip characteristics after resurfacing, using the proposed technique. Laser resurfacing, done with a few more passes at the philtrum area, reshapes the anatomic-aesthetic youthful appearance of the upper lip and fully recovers the appearance of the Cupid’s bow. Results proved to be about the same when using the Coherent or the Sharplan laser. The sum of “very good” (e.g., equal to >80 percent clinical improvement and >60 percent improvement for “good” results, for both systems) was as follows: (1) Sharplan, rate of success 52 percent “very good” and 35 percent “good,” and (2) Coherent, rate of success 40 percent “very good” and 50 percent “good” against a group of 118 patients treated with each laser. No bad results were scored. Histologic samples after laser resurfacing showed effects down to the reticular dermis, which, anatomically, is closely related to muscle layer because of the nonexistence of a subcutaneous fat layer. Two months later, tissue showed signs that typically appear after laser resurfacing, that is to say, there was a rich broad band of compacted collagen present immediately below the epidermis-dermis junction. This band could be very well distinguished from collagen before laser treatment, which was lax and presented clear signs of elastosis. The orbicular, the main muscle surrounding the mouth, is attached to the dermis with practically no layer of fat in between. Thus, when the technique is used as described, extra laser passes will promote a more compacted rich band of collagen that efficiently stretches the fibers of the mirtiform muscle which lies in direct connection with the philtrum and its physiognomy. Extra pulling on this particular location, related to the philtrum, will result in reshaping the anatomic and aesthetic lip configuration. Laser resurfacing offers possibilities of enhancing the results of lip rejuvenation by improving the vermilion appearance and the aesthetic pattern with little risk of complications.

Clinical and histologic effects of facial skin rejuvenation with pulsed- and continuous-wave flash-scanned CO2 lasers

LEARNING OBJECTIVES The reader is presumed to have some understanding of the use of lasers in skin resurfacing. After studying the article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page 409. BACKGROUND The selection of the ideal laser for facial resurfacing is debatable. OBJECTIVE The purpose of the study was to determine whether any clinical and histologic differences existed in short- and long-term results after treatment with the Coherent UltraPulse 5000G laser (a pulsed laser; PL) and the Sharplan Silk Touch laser (a continuous-wave laser [CWL] with a flash scanner). METHODS Eight patients underwent facial resurfacing treatment on different areas. In each case, one side was treated with the PL and the other with the CWL. The condition of the patients and the treated tissue were monitored periodically after treatment. Histologic assessment of punch biopsies was performed 3 months and 1 year after treatment with hematoxylin-eosin, Masson trichromic, and Verhoeffs stains. RESULTS The areas treated with the PL achieved earlier epithelialization with a good appearance. Longer-lasting erythema was observed on the side treated with the CWL. On a histologic level, although the PL-treated tissue epithelialized more quickly, at 3 months and 1 year the collagen was better compacted and better aligned in the CWL-treated tissue, and the macroscopic appearance of the CWL-treated areas was more enhanced. CONCLUSIONS The more active vascularization seen in the CWL-treated tissue, associated with the longer-lasting erythema and possibly greater collateral thermal injury, is possibly the reason for the better collagenization and remodeling of collagen and elastin fibers as compared with the results with the PL-treated tissue. This may explain the longer effect associated with CWL treatment. The clinician would do well to bear in mind the histologic findings as well as the macroscopic clinical results when assessing the long-term effects of laser skin resurfacing. (Aesthetic Surg J 2001;21:399-411.).

Laboratory trials using 514 and 585 nm-30 ms pulses on portwine stains (PWS) do not cause evident histological differences

In order to investigate histological results produced by laser wavelengths 514 and 585 nm (Monoline Argon Laser and cw Dye Argon Laser), tests were carried out on a haemangioma situated on the neck of a male adult. The tests were done using the hexascan, previously modified to receive two fibers, which could separately direct the wavelengths 514 and 585 nm (1 watts and 30 ms pulses), with slight pauses during the treatment of one area and another, but both areas having identical characteristics. Random histological samples were taken previous to treatment, immediately after, and a month following treatment, processing them with Masons Trichromic. Analysis and evaluation of the samples were performed by two researchers, strange to the investigation. In addition to the typical tissue reactions to relatively long Argon pulses (longer than 100 ms), it was found that there were no significant differences in the skin and vessels histological reactions, when both wavelengths 514 and 585 nm were used.

Laboratory and clinical data on wound healing by low-power laser from the Medical Institute of Vilafortuny, Spain

Low power laser has been claimed, both at laboratory and for clinical treatment to activate wound healing. Chronic ulcers respond very positively to laser treatment when particular rules of irradiation are take into account. The multiple etiology of chronic ulcers is not conductive to treatment selection, including laser treatment, if the associated illness is not taken into consideration. For more than 14 years our clinical experience have been significantly positive using lasers in the treatment of chronic ulcers. Our causistic, based on 242 cases treated from 1975 through 1983, has kept in many cases very close follow-up for an extended time periods of up to six years after healing. By controlling photographically and microscopically a chronic venous ulcer submitted to low density laser irradiation, as well as by studying the process of reparation of experimental ulcers and burns, produce on laboratory animal, the healing effects of laser radiation can be followed. Statistically, it is possible to estimate that low intensity laser irradiation produces faster reparation of damage tissue.