Transcript Non – Ablative LASERs For Skin Rejuvenation

LASER Applications for
Skin Rejuvenation
Dr. Tzermias Christopher
Athens
Greece
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LASER Applications for
Skin Rejuvenation
Traditional rejuvenation techniques
(CO2, Er:YAG) characterized
by top–to–bottom injuries,
sacrifice epidermis to achieve
subsequent dermal remodeling.
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Ablative LASERs Produce:
Epidermal Ablation:
• Improvement in skin surface texture
and dyspigmentation but
• Prolonged healing time
• High incidence of complications
Dermal Injury Thermal Contraction:
• Immediate collagen denaturation and
shrinkage
• Collagen remodeling
• Wrinkle improvement
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Ablative LASERs for
Skin Rejuvenation
• The primary mechanism for wrinkle reduction
after laser resurfasing appears to be a
dermal wound and new collagen formation.
Therefore, is epidermal ablation really
necessary for skin rejuvenation?
• Theoretically, techniques that induce a
dermal wound should lead to cosmetic
improvement.
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Non – Ablative LASERs
For Skin Rejuvenation
“Selective dermal remodeling”
theoretically can be accomplished by:
Deeply penetrating laser beam
• Dermal Heating
• New Collagen Production
• Cosmetic Enhancement
Surface – Cooling Device
• Epidermal Preservation
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Non – Ablative
“Subsurface Remodeling”
has been reported to be induced by:
Pulsed – Dye Laser
(P.Bjerriug et al, J. Cutaneous laser therapy,2000,2:9-15)
1320 nm - Nd : Yag Laser
(D.J. Goldberg, Dermatol. Surg. 2000, 26 : 915-918)
1450 nm - Diode Laser
(D.J. Goldberg, Lasers in Syrg and Med, 2000, 26:196-200)
Intense Pulsed Light
(D.J. Goldberg, K.B. Culter, Lasers in Surg. And Med, 2000,26:196-200)
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Non- Ablative LASER for
Skin Rejuvenation
Pulsed-Dye Laser
• Wavelength 585 nm selectively targets
hemoglobin and melanin
• Pulse duration: 0,35 millisecond
(shorter than traditional 0,45 msec 585 PDLaser)
• Low fluence range: 2-4 J/cm2 in order to
insult but not injure the microrasculacture.
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Pulsed – Dye Laser
Histologic Evaluation
Statistically significant increase in the production of
type III procollagen.
Hypothesis:
Endothelial cells insulted by laser, release
inflammatory mediators that trigger fibroblasts.
Clinical Evaluation
• Lack of purpura, no side effects
• Statistically significant wrinkle improvement
greater in Class II and III.
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Non- Ablative LASER for Skin Rejuvenation
1320 nm Nd:Yag LASER
• Wavelength with significant
scattering properties.
• Approximately 20-millisecond macropulse
(train of three 300-microsecond pulses)
• Coupled with a cryogen – spray
cooling system of epidermis
• Thermal sensor built into the handpiece to
accurately document the temprature rise after
pulse and aid the physician in choosing an
optimal treatment fluence.
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1320 nm Nd :Yag LASER
Histologic evaluation
New collagen formation in all subjects at
6 months after the fourth treatment
Clinical Evaluation
• In general terms, mild clinical improvement
and in few subjects lack of improvement
• Histologic changes are not necessarily
correlate with wrinkle reduction
• Absence or minimal side effects.
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1450 nm Diode Laser
• Tissue scattering properties similar to 1320nm Nd: Yag
• Low-power system: longer exposures (150-250msecs)
are required to achieve sufficient fluences for selective
dermal heating
• Dynamic Cooling Device :
(pre–, intermediate-, and post-laser cryogen cooling)
• Clinical Endpoint: Small edematous papules vs
1320 nm Nd :Yag post treatment erythema.
• Clinical Evaluation: Subjective and objective wrinkle
improvement seem to be modest and comparable to
1320 nm Nd :Yag laser.
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Advantages of
Non – Ablative LASERs
• Absence of post - operative healing period:
Ideal for the working individual
• Minimal adverse effects
• Helpful in maintaining the rejuvenating
effect of ablative laser systems
• Adjuctive method to laser treatment for
face telangiectasia and age spots
• No need for anesthesia
• No need for post - operative topical agent
administration.
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Disadvantages Of Non – Ablative LASERs
• Definately more subtle wrinkle improvement
than those seen with ablative laser.
• Delayed clinical improvement.
(subsequent collagen deposition occurs orer a period of several months)
• Microscopic changes are not always associated with
cosmetic enhancement.
• Abseuce of improvement in skin surface texture and
dyspigmentation (midinfrared lasers)
• Multiple treatment sessions
• Higher cost than other resurfacing modalities that also
provide mild improvement such as microdermabrasion
and superficial chemical peels.
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LASERLINE CLINICS
“Non –Ablative LASERs and complementary
techniques for skin rejuvenation”
C. Tzermias, C. Gintzou, T. Anthopoulos
• Objective:
Clinical evaluation of wrinkle improvement and
patient satisfaction using non- ablative lasers
alone and in combination with
microdermabrasion for skin rejuvenation
• Material:
Total cases: 50 / Age range 35-60 years
Skin types: I – III / Solar and age – related wrinkles
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Methods
•All subjects were treated 3 times over a period of
12-14 weeks with non- ablative midinfrared lasers:
•1450 nm Diode laser
Fluence range: 10-14 J/Cm2
•1320 nm Nd :Yag laser
Fluence range: 28-36 J/Cm2
•Half of subjects were simultaneously submitted to
seven microdernabration facial treatments at 15 days
internal
•Clinical and photographic assessments were
recorded monthly
•Final evaluation: one month after the third laser
treatment
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“Non–Ablative LASERs and complementary
techniques for skin rejuvenation”
Results
• Neither 1450nm Diode nor 1320nm Nd :Yag laser
induced statistically significant macroscopic wrinkle
improvement.
• Similar disappointing rates of clinical wrinkle
improvement in both groups:
Group A: Non-Ablative laser treatment alone
Group B: Non-Ablative laser combined with
microdermabrasion.
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Results
•Considerably higher satisfaction score in
group treated with non – ablative laser
and microdermabration
•We propose the use of a complementary
minimally aggressive technique such as
microdermabrasion in order to restore a
youthful appearance to the epidermis and
increase patient satisfaction.
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In conclusion
•Non – ablative lasers is a safe treatment,
suitable for patients with realistic
expectations and who are unwilling or unable
to undergo an ablative skin resurfacing laser
procedure.
•In combination with microdermabration can
achieve non-invasively an overall skin
improvement (clearer, smoother, brighter,
younger-appearing).
•Complementary method to vascular and
pigmented laser treatments.
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