Fractional Erbium laser in the treatment of photoaging: randomized comparative, clinical and histopathological study of ablative (2940nm) vs. non-ablative (1540nm) methods after 3 months

Abstract

BACKGROUNDFractional non-ablative lasers keep the epidermis intact, while fractional ablative lasers remove it, making them theoretically more effective.OBJECTIVESTo evaluate the clinical and histological alterations induced by fractional photothermolysis for treating photoaging, comparing the possible equivalence of multiple sessions of 1540nm Erbium, to one session of 2940nm Erbium.METHODSEighteen patients (mean age 55.9) completed the treatment with three sessions of 1540nm fractional Erbium laser on one side of the face (50 mJ/mB, 15ms, 2 passes), and one session of 2940nm on the other side (5mJ/mB, 0.25ms, 2 passes). Biopsies were performed before and 3 months after treatment. Clinical, histological and morphometric evaluations were carried out.RESULTSAll patients presented clinical improvement with no statistically significant difference (p> 0.05) between the treated sides. Histopathology revealed a new organization of collagen and elastic fibers, accompanied by edema, which was more evident with the 2940nm laser. This finding was confirmed by morphometry, which showed a decrease in collagen density for both treatments, with a statistical significance for the 2940nm laser (p > 0.001).CONCLUSIONSThree 1540nm sessions were clinically equivalent to one 2940nm session. The edema probably contributed to the positive results after three months, togheter with the new collagen and elastic fibers organization. The greater edema after the 2940nm session indicates that dermal remodeling takes longer than with 1540nm. It is possible that this histological superiority relates to a more prolonged effect, but a cohort longer than three months is needed to confirm that supposition.

White Fibrous Papulosis of the Neck Treated With Fractionated 1550-nm Erbium Glass Laser: A Case Report

“…Besides, the elastic fibers were better arranged and denser, with increased expression for up to one year after three laser treatments. 8,9 Since WFPN is arguably a feature of photoaging or intrinsic aging, with characteristically superficial dermal fibrosis of scant elastolysis, it is presumed that fractional non-ablative laser can be a suitable alternative for this disease entity. The remodeled fine elastic fibers and the increased collagen deposition in the upper dermis, therefore, correlated with the clinical improvement of smaller and smother lesions.…”

Fractional 1,550nm Ytterbium/Erbium fiber laser in the treatment of lichen amyloidosis: Clinical and histological study

“…However, NAFL is safe to use in other anatomical sites that are not amenable to ablative resurfacing modalities, especially in areas with thin skin such as hands, forearms, shin, and neck; therefore, it may provide an alternative for patients with LA at these sites . In addition, this technology shows a clinical outcome equivalent to ablative fractional laser with a more favorable safety profile, especially in darker skin type .…”

Assessment of Laser Effects on Skin Rejuvenation

“…A comparison between the action of fractional ablative lasers and that of non-ablative ones on facial skin revealed clinical improvements in both techniques; however, collagen and elastin formation and edema in skin treated by the ablative fractional erbium laser were more than non-ablative one. 44 Lasers resurfacing of skin as peeling could remove fine wrinkles of skin although, however potentially have the advantages to treat deep wrinkles by collagen making stimulation. 45 Skin healing in deep peeling and laser resurfacing is known as like wound healing mechanism and depends on the depth of the lesion.…”