Skin responses to fractional photothermolysis

Laubach, Hans-Joachim; Tannous, Zeina; Anderson, R. Rox; Manstein, Dieter

doi:10.1002/lsm.20254

Cited by 448 publications

(456 citation statements)

References 18 publications

(20 reference statements)

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“…More recent evidence indicates that such designation is a misnomer, as dermal components are readily identified there, as well [25]. Additionally, melanin concentration within the columns of damage was found to be significantly higher than that in the surrounding tissue [26], with clinical correlation of minute brown crusts evident at 3 days post-treatment, just as MENDs are being eliminated through the skin.…”

Section: Discussionmentioning

confidence: 99%

Histologic and ultrastructural analysis of melasma after fractional resurfacing

2008

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Background and Objective: Fractional photothermolysis is a popular treatment option for photodamaged skin and other cutaneous conditions. Recently, successful improvement in melasma has been achieved with this laser system. We undertook this study to evaluate the ultrastructural changes associated with fractional laser treatment of melasma. Study Design/Materials and Methods: Ten subjects with skin types III and IV and a clinical diagnosis of epidermal melasma were treated with a 1,550-nm erbium:-glass laser delivering light in a fractional manner (Fraxel SR 750, Reliant Technologies, Inc., Mountain View, CA) every 2 weeks for a total of four sessions. Biopsies were obtained from all subjects both before treatment and at 3 months following the final treatment. All biopsies were analyzed by light and electron microscopy for treatmentinduced changes. In addition, a secondary endpoint of the study was to assess for clinical improvement in melasma following fractional resurfacing. This assessment was performed by the investigator using pre-and post-treatment photographs. Results: Light microscopy on post-treatment specimens showed a relative decrease in melanocytes compared to the pre-treatment ones. Post-treatment electron microscopy revealed fewer melanocytes and a relative absence of melanin in the surrounding keratinocytes compared to pre-treatment specimens. In addition, six subjects with skin type III were determined to have good improvement, whereas four subjects with skin type IV had fair improvement, as assessed by the investigator. Conclusion: Post-treatment ultrastructural changes are consistent with an elimination process and may help to explain clinical improvement following laser treatment.

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Section: Discussionmentioning

confidence: 99%

Histologic and ultrastructural analysis of melasma after fractional resurfacing

2008

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“…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].…”

Section: Introductionmentioning

confidence: 99%

Fractional CO₂ laser‐assisted drug delivery

et al. 2010

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Background and Objectives: Ablative fractional resurfacing (AFR) creates vertical channels that might assist the delivery of topically applied drugs into skin. The purpose of this study was to evaluate drug delivery by CO 2 laser AFR using methyl 5-aminolevulinate (MAL), a porphyrin precursor, as a test drug. Materials and Methods: Two Yorkshire swine were treated with single-hole CO 2 laser AFR and subsequent topical application of MAL (Metvix 1 , Photocure ASA, Oslo, Norway), placebo cream and no drug. MAL-induced porphyrin fluorescence was measured by fluorescence microscopy at skin depths down to 1,800 mm. AFR was performed with a 10.6 mm wavelength prototype CO 2 laser, using stacked single pulses of 3 millisecond and 91.6 mJ per pulse. Results: AFR created cone-shaped channels of approximately 300 mm diameter and 1,850 mm depth that were surrounded by a 70 mm thin layer of thermally coagulated dermis. There was no porphyrin fluorescence in placebo cream or untreated skin sites. AFR followed by MAL application enhanced drug delivery with significantly higher porphyrin fluorescence of hair follicles (P<0.0011) and dermis (P<0.0433) versus MAL alone at skin depths of 120, 500, 1,000, 1,500, and 1,800 mm. AFR before MAL application also enhanced skin surface (epidermal) porphyrin fluorescence. Radial diffusion of MAL from the laser-created channels into surrounding dermis was evidenced by uniform porphyrin fluorescence up to 1,500 mm from the holes (1,000, 1,800 mm depths). Skin massage after MAL application did not affect MAL-induced porphyrin fluorescence after AFR. Conclusions: Ablative fractional laser treatment facilitates delivery of topical MAL deeply into the skin. For the conditions of this study, laser channels approximately 3 mm apart followed by MAL application could produce porphyrins throughout essentially the entire skin. AFR appears to be a clinically practical means for enhancing uptake of MAL, a photodynamic therapy drug, and presumably many other topical skin medications. Lasers Surg.

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“…Más recientemente, Laubach ha comunicado no haber observado signos de degradación del colágeno tipo II tres meses después del tratamiento láser (23), lo que estaría a favor de la aceleración cicatricial que produce el tratamiento láser.…”

Section: Discussionunclassified

Ventajas de la cicatrización cutánea asistida por láser (LASH)

Mordon

Trelles²

2011

Cir. plást. iberolatinoam.

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ResumenLa fase final de toda cirugía es la sutura y su cicatriz correspondiente y, frecuentemente, ésta es la única secuela visible de una intervención. La técnica LASH (cicatrización cutánea asistida por láser), estimula los mecanismos de reparación de la piel por efecto térmico, condicionando la calidad de la cicatrización.Estudios experimentales en ratones comparando los resultados obtenidos en heridas quirúrgicas radiadas con laser diodo 810 nm tras ser suturadas, con los obtenidos en igual tipo de heridas suturadas de manera convencional, han demostrado que se consiguen cicatrices mucho menos visibles cuando se practica el tratamiento con láser.La histología confirma, comparativamente, una notable aceleración del proceso cicatricial con modificación del TGFß (Transforming Growth Factor-Beta) directamente implicado en la reparación tisular, en los animales en los que la sutura fue asistida por láser. Igualmente, el análisis tensiométrico demostró mayor resistencia a la acción de estiramiento mecánico en estas heridas.Estudios clínicos en pacientes sometidos a dermolipectomia, reducción mamaria y estiramiento facial, demuestran que al tratar con LASH una parte o una de las líneas de sutura, los análisis realizados tanto por los pacientes como por cirujanos independientes a los 8 días, 3 meses y un año, evidencian resultados más favorables para la técnica láser, Las dosis eficaces determinadas para las fluencias láser están entre 80 y 120 J/cm 2 .La técnica LASH es simple de efectuar, reproducible, rápida y ofrece una clara evidencia de que es posible reducir considerablemente la cicatriz, logrando que ésta sea de mejor calidad y más estética.Palabras clave Cicatrización, Láser.Cicatrización asistida, LASH. Código numérico 153-1545 AbstractSuture is the final stage of surgery and as a consequence, a scar is frequently the only visible effect after an operation. LASH technique ( Laser Assisted Scar Healing) produces thermal effects to stimulate mechanisms for tissue repair that will determine the quality of the scar.In the experimental phase, rats were irradiated with 810 nm diode-laser after surgical wounds were sutured, and then, compared to another group of rats with the same type of wounds which were sutured with conventional techniques. The results were that those rats treated with laser had less visible scars.Histology comparatively confirmed a notable acceleration in the scarring process with modification of the TGFß (Transforming Growth Factor-Beta), which is directly involved in tissue repair in those rats treated with laser. The tensiometric analysis also demonstrated a better resistance to mechanical stress of wounds.Clinically, in dermolipectomy patients, breast reductions and facial lifts, in which part of the sutures were treated with LASH, at 8 days, 3 months and 1 year controls, evaluated by independent surgeons to the study and by patients, statistical results were more favourable for patients treated with LASH technique. The effective doses determined for treatment were laser fluencies between...

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Skin responses to fractional photothermolysis

Cited by 448 publications

References 18 publications

Histologic and ultrastructural analysis of melasma after fractional resurfacing

Histologic and ultrastructural analysis of melasma after fractional resurfacing

Fractional CO₂ laser‐assisted drug delivery

Ventajas de la cicatrización cutánea asistida por láser (LASH)

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Skin responses to fractional photothermolysis

Cited by 448 publications

References 18 publications

Histologic and ultrastructural analysis of melasma after fractional resurfacing

Histologic and ultrastructural analysis of melasma after fractional resurfacing

Fractional CO2 laser‐assisted drug delivery

Ventajas de la cicatrización cutánea asistida por láser (LASH)

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Fractional CO₂ laser‐assisted drug delivery