Micro‐fractional ablative skin resurfacing with two novel erbium laser systems

Abstract

Background and Objectives: Fractional ablation offers the potential benefits of full-surface ablative skin resurfacing while minimizing adverse effects. The purpose of this study was to evaluate the safety, damage profile, and efficacy of erbium fractional lasers. Materials and Methods: Histology from animal and human skin as well as clinical evaluations were conducted with erbium YAG (2,940 nm) and erbium YSGG (2,790 nm) fractional lasers varying pulse width, microbeam (mb) energy, number of passes, and stacking of pulses. Results: Single-pulse treatment parameters from 1 to 12 mJ per 50-70 mm diameter microbeam and 0.25-5 milliseconds pulse widths produced microcolumns of ablation with border coagulation of up to 100 mm width and 450 mm depth. Stacking of pulses generated deeper microcolumns. Clinical observations and in vivo histology demonstrate rapid re-epithelization and limited adverse side effects. Facial treatments were performed in the periorbital and perioral areas using 1-8 passes of single and stacked pulses. Treatments were well-tolerated and subjects could resume their normal routine in 4 days. A statistically significant reduction in wrinkle scores at 3 months was observed for both periorbital and perioral wrinkles using blinded grading. For periorbital treatments of four passes or more, over 90% had !1 score wrinkle reduction (0-9 scale) and 42% had !2. For perioral wrinkles, over 50% had substantial improvements (!2). Conclusion: The clinical observations and histology findings demonstrate that micro-fractional ablative treatment with 2,790 and 2,940 nm erbium lasers resulted in safe and effective wrinkle reduction with minimal patient downtime. The depth and width of the ablated microcolumns and varying extent of surrounding coagulation can be controlled and used to design new treatment procedures targeted for specific indications and areas such as moderate to severe rhytides and photodamaged skin.

Fractional CO2 laser‐assisted drug delivery

“…Fractional ablative lasers are commercially available as CO 2 lasers (10,600 nm) and erbium lasers (Er:YAG, 2,940 nm) [3][4][5]. Tissue absorption at these wavelengths is dominated by water.…”

“…AFR damages a fraction of the skin while leaving microscopic intervening areas of unexposed skin that are capable of remodeling the skin without scarring [1,2]. Fractional ablative procedures are available with carbon dioxide laser (CO 2 laser, 10,600 nm) and erbium YAG laser (Er:YAG laser, 2,940 nm) [3][4][5]. The concept of AFR has so far been used for dermal remodeling in the treatment of photodamaged facial skin, rhytides, acneiform scarring, and burn scar remodeling [3,[6][7][8][9][10].…”

“…Fractional ablative procedures are available with carbon dioxide laser (CO 2 laser, 10,600 nm) and erbium YAG laser (Er:YAG laser, 2,940 nm) [3][4][5]. The concept of AFR has so far been used for dermal remodeling in the treatment of photodamaged facial skin, rhytides, acneiform scarring, and burn scar remodeling [3,[6][7][8][9][10]. Theoretically, AFR may also facilitate penetration and distribution of topically applied drugs, since the ablated laser holes extend into dermis, thereby possibly acting as channels for drug uptake.…”

Ablative fractional lasers (CO2 and Er:YAG): A randomized controlled double‐blind split‐face trial of the treatment of peri‐orbital rhytides

“…The findings about ablative fractional photothermolysis of rhytides that have been published so far are encouraging, but they are inconsistent in detail as far as study design and the respective efficacy of different laser modalities are concerned. Whereas several studies claim encouraging results of erbium lasers (e.g., [12][13][14]), the same holds true for fractional CO 2 ablation [15][16][17]. There is very little evidence on the comparative safety and efficacy of both methods, but the limited scope of the literature to date suggests a roughly equivalent status [18], just as it does for non-fractional applications [4][5][6][7].…”

Introduction to the special dermatology issue

“…Dierickx et al [7] report a micro-fractional ablative device with capability of varying wavelength and pulsewidth to achieve varying depths and widths of vaporized columns, as well as varying the surrounding coagulation zone. Human and animal histology was evaluated as well as clinical observations of 21 peri-orbital areas and 19 perioral areas.…”