Nazanin Saedi

Fractionation: A New Era in Laser Resurfacing

Fractional photothermolysis combines the benefits of fully ablative lasers with significantly reduced downtime and fewer complications. Skin is treated in a fractional manner, with narrow cylinders of tissue being thermally heated and normal adjacent skin left unaffected, and the fractional devices have shown effectiveness in treating a variety of conditions, especially scarring and photodamage. There are many devices that use fractional photothermolysis, and practitioners are becoming more adept at using optimal parameters to induce near CO(2) laser benefits. Fractionated lasers have become the cornerstone of a minimally invasive treatment regimen and have ushered in a new era of laser skin rejuvenation.

Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments.

BACKGROUND The fractionated nonablative 1440-nm laser creates microscopic thermal wounds within the epidermis and the dermis and is used clinically to improve tone, texture, and color of skin. OBJECTIVE We sought to investigate the use of this device to treat facial pores and to improve skin texture. METHODS Twenty patients received 6 treatments at the highest tolerable energy level performed 2 weeks apart. Photographic assessments using the VISIA-CR (Canfield Scientific Inc, Fairfield, NJ) imaging system were performed. The pore score was calculated, which is the percentage of the skin surface that has detected pores. Subjective measurements (0-4 scale) were recorded by both the subject and investigator regarding pore appearance, skin texture, and overall skin appearance. Treatment discomfort was scored by patients (1-10 scale). RESULTS After 6 treatments there was a significant reduction in pore score (P < .002). Total average pore score at baseline was 2.059 ± 0.8 and 2 weeks after the final treatment it was 1.700 ± 0.8, resulting in a 17% average reduction in pore score. Study investigators reported average scores being 1.95 ± 0.3 for improved pore appearance and 2.75 ± 0.2 for improved overall appearance (0-4 scale). Subjects noted average scores of 1.9 ± 0.5 for improvement of the appearance of pores and 2.85 ± 0.4 for improvement of overall appearance (0-4 scale). The average discomfort score during treatments was reported to be 4.6 ± 0.1 (1-10 scale). There were no serious adverse effects or long-term side effects. LIMITATIONS Small sample size and limited follow-up are study limitations. CONCLUSIONS A series of treatments with the nonablative low-energy fractional 1440-nm laser appears to be safe and effective for reducing detectable pores and improving overall skin appearance.

Fractionation: past, present, future.

The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.

Fractionated ablative carbon dioxide laser for the treatment of rhinophyma

Rhinophyma is a progressive and disfiguring proliferative disorder of the nose, which is related to chronic rosacea. Many different treatment modalities have been utilized both alone and in combination including: loop cautery, CO2 laser, argon laser, dermabrasion, cryotherapy, radiotherapy, full‐thickness excision, skin graft, flap reconstruction, and cold scalpel. CO2 resurfacing has been considered first line therapy but is often associated with a shiny, scarred appearance, with patulous pores, and with loss of pigmentation. We report a technique using aggressive parameters with the fractionated ablative CO2 laser, resulting in improvement of appearance with very few complications.

Evaluation of a 1540-nm and a 1410-nm Nonablative Fractionated Laser for the Treatment of Striae.

BACKGROUND Aesthetically, striae distensae (SD) are a source of great concern. No treatment modality is currently considered the gold standard. However, studies of nonablative fractionated lasers (NAFLs) have been promising. OBJECTIVE To evaluate and compare the clinical and histopathologic efficacy and safety of a 1540-nm NAFL and a 1410-nm NAFL for the treatment of SD. METHODS AND MATERIALS Nine patients with abdominal striae were treated for 6 sessions—half of the abdomen was treated with a 1540-nm NAFL whereas the other half was treated with a 1410-nm NAFL. Photographs were taken at baseline and at the 3-month follow-up visit, when subjects were given a questionnaire. Two blinded dermatologists scored the photographs using a pre-established clinical scale. Biopsies were taken from 2 subjects and graded by 2 dermatopathologists using a pre-established pathology scale. RESULTS All 9 subjects demonstrated clinical improvement bilaterally after treatment. Skin biopsies after treatment showed an increase in epidermal thickness, dermal thickness, and collagen and elastin density when compared with baseline. Clinical and histopathological differences between the 2 lasers were not statistically significant. CONCLUSION Treatment with both the 1540-nm and the 1410-nm NAFL was shown to improve SD clinically and histopathologically. Further studies are needed to optimize treatment parameters.

Combined treatment for facial rejuvenation using an optimized pulsed light source followed by a fractional non‐ablative laser

Combination laser treatments can potentially increase the effectiveness of treatment without the additional downtime associated with another procedure.

Evaluation of a long pulsed 1064-nm Nd:YAG laser for improvement in appearance of cellulite

Abstract Background: Cellulite is a common, unwanted condition, which is challenging to treat. Objectives: The objective of this investigation was to evaluate safety and effectiveness of a long-pulsed 1064 Nd:YAG laser as a method for improvement in cellulite appearance and to evaluate parameter selection. Materials and methods: Twenty-two female subjects with posterior leg cellulite were randomly assigned to treatment of left or right thigh with higher energy treatment with cryogen spray cooling (CSC) (10-mm spot size; 50 J/cm2; 50-ms pulse duration and CSC settings of 30-ms duration with a 20-ms delay) or lower energy treatment with no CSC (10 mm; 20 J/cm2; 50 ms). Subjects received three treatments at 4 weeks intervals. Digital photographs and circumference measurements were taken pre-treatment and up to 6 months post-treatment. Results: Nineteen subjects completed three treatments and 16 subjects completed 6-month follow-up. Circumference measurements pre- and post-treatment were not significantly different. Blinded evaluators noted mild improvement in three of seven subjects in high energy group and moderate improvement in two of nine subjects in low energy group. Conclusion: Multiple passes with a long-pulsed 1064 Nd:YAG achieved mild or moderate improvement in some subjects as rated by blinded evaluators.

Port wine stain treated with a combination of pulsed dye laser and topical rapamycin ointment

A port wine stain (PWS) is a type of capillary vascular malformation composed of malformed, dilated blood vessels within the papillary and reticular dermis. Currently, pulsed dye laser (PDL) is considered the therapeutic gold standard, although greater than 90% of lesions may be refractory to treatment. Studies have shown that a delay in treatment results in a higher proportion of patients who develop hypertrophy and nodularity within lesions that become more resistant to therapy. Therapeutic resistance is multifactorial, but is believed to be largely due to revascularization after laser treatment. Oral sirolimus and topical imiquimod have shown promise as adjunctive therapies to minimize post‐laser revascularization, but both have significant side effects. We wish to demonstrate the utility of adjunct topical sirolimus to reduce revascularization after PDL treatment.

Non-ablative fractional resurfacing in the treatment of scar contracture.

A 28‐year‐old female presented with extensive scarring after a traumatic injury to her right lower extremity. She had been hit by a vehicle one year prior to presentation and had several open fractures with extensive overlying cutaneous damage, which required multiple surgeries and skin grafts. She had limited range of motion of the affected limb secondary to scar contracture.

Disseminated superficial actinic porokeratosis improved with fractional 1927-nm laser treatments

Disseminated superficial actinic porokeratosis (DSAP) is an inherited disorder of keratinization readily diagnosed through clinical and histologic examination. While generally benign in nature, the lesions can have profound psychosocial implications for patients. Although no cure exists, a number of treatment modalities, from topical medications to laser and light devices, have been reported with variable success. The authors report two cases of DSAP treated with the 1927-nm thulium fiber fractional laser along with a review of the treatment literature for DSAP. This therapy is convenient and safe with nearly no downtime or morbidity associated with pigment or textural changes.