This pilot study demonstrates that the Smartepil LS long pulse Nd:YAG 1,064 nm laser can yield results similar to sclerotherapy in the treatment of small leg telangiectasias. Combination of both methods could increase response to treatment.
Rhytides represent an aesthetic problem for a large percentage of the population. Many methods, both noninvasive and invasive, have been used for the treatment of wrinkles. Recently, the long-pulsed 1064-nm Nd:YAG laser has been shown to enhance dermal collagen synthesis without damaging the epidermis. The purpose of this preliminary study is to evaluate the use of the long-pulsed Nd:YAG laser in the nonablative treatment of periocular and perioral wrinkles. Ten patients with facial wrinkles were treated with the long-pulsed 1064-nm Nd:YAG laser, at a spot size of 5 mm in diameter, energy density of 13 J/cm2, exposure time per pulse of 300 microseconds, and a repetition rate of 7 Hz. All patients had a total of three treatments, once every 2 weeks. Subjective (patient satisfaction index [SI]) and objective (both physician- and computer program-based clinical index [CI]) assessments were performed before the first and third treatment sessions, and at 2, 4, and 6 months after the last treatment. At 6 months after the final treatment session, the patients' subjective SI was maintained at 40%, and had peaked at 50% 2 months after the final session. Physician assessment showed a CI of 40% at the 6-month assessment point and the computer program showed a 50% CI. The greatest level of effect with long-pulsed Nd:YAG laser nonablative skin rejuvenation for facial wrinkles was seen 2 months after the final treatment. Effects were still visible at the 6-month period, but showed a tendency to decrease. Maintenance treatments are required to achieve good patient satisfaction.
The erbium:yttrium-aluminium-garnet (Er:YAG) laser has recently been used in the fractional resurfacing of photo-aged skin. Our study evaluated the results after one single session of fractional resurfacing with Er:YAG. Thirty women participated in the study, with an average age of 46 years, skin types from II to IV, and wrinkle grades I to III. The 2,940 nm Er:YAG system used (Pixel, Alma Laser, Israel) had variable pulse durations (1 ms to 2 ms) and energy densities (800 mJ/cm(2) to 1,400 mJ/cm(2)) which, together with the number of passes (four to eight), were selected as a function of wrinkle severity. All patients received only one treatment. Postoperative side effects were evaluated. The number of wrinkles was documented with clinical photography and was scored. Histological assessment was carried out on two patients before and 2 months after treatment. All patients completed the study. Of the patients, 93% reported good or very good improvement of the degree of their wrinkles, with a satisfaction index of 83%. Pain was not a problem during treatment, and there were no side effects except for in one phototype IV patient, who had hyperpigmentation. Histology 2 months after the single treatment demonstrated younger morphology of both the epidermis and dermis, with improvement of the pretreatment typical elastotic appearance. At the parameters used in our study, only one treatment session of Er:YAG laser could achieve effective skin rejuvenation, with effects recognized in both the dermis and, more importantly, the epidermis. This regimen offers an interesting alternative to the conventional approach of multi-session fractional resurfacing.
Ablative laser resurfacing with the CO2 and Er:YAG lasers has become a well-accepted and well-reported modality for skin rejuvenation of photoaged and photodamaged skin. However, the side effects associated with these lasers, such as exudation and crusting followed by prolonged erythema, are often socially disturbing for the patient. A nonablative 1,320-nm pulsed Nd:YAG system has been developed that controls dermal collagen damage while preserving the epidermis. Thirteen patients are presented on whom periocular wrinkle treatment was carried out during two sessions 1 month apart. Side effects were minimal. Histology showed improvement in the previously typical sun-damaged dermis. However, although physician assessment noted a trend toward macroscopic improvement, almost all patients failed to see any improvement. The authors conclude that further studies of the ideal parameters are required before the 1,320-nm Nd:YAG laser can be indicated successfully in stand-alone, nonablative wrinkle removal. In addition, patients should be selected carefully, and a complementary minimally aggressive technique should be used to restore a youthful appearance to the epidermis.
Wavelengths of 595 plus 1450 nm for skin rejuvenation produced good results with much higher patient satisfaction than those obtained with the 595- or 1450-nm wavelengths alone.
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