1

LASER Applications for Skin Rejuvenation

Dr. Tzermias Christopher

AthensGreece

2

LASER Applications for Skin Rejuvenation

Traditional rejuvenation techniques(CO2, Er:YAG) characterized

by top–to–bottom injuries, sacrifice epidermis to achieve subsequent dermal remodeling.

3

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

4

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.

5

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

6

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)

7

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.

8

Pulsed – Dye Laser

Histologic EvaluationStatistically 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.

9

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.

10

1320 nm Nd :Yag LASER

Histologic evaluationNew 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.

11

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.

12

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.

13

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.

14

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

15

Methods•All subjects were treated 3 times over a period of 12-14 weeks with non- ablative midinfrared lasers:

•1450 nm Diode laserFluence range: 10-14 J/Cm2

•1320 nm Nd :Yag laserFluence 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

16

“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 aloneGroup B: Non-Ablative laser combined with

microdermabrasion.

17

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.

18

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.