SPF-RR sequential photothermal fractional resurfacing and remodeling with the variable pulse Er:YAG laser and scanner-assisted Nd:YAG laser.

BACKGROUND AND OBJECTIVE: Many different lasers, polychromatic high-intensity light sources (PCLs), and RF devices have claimed clinical efficacy in rejuvenating the skin. In this study, the sequential combination of two different laser wavelengths was evaluated to produce reliably significant clinical improvements optimizing treatment parameters.

METHODS: The left volar aspects of the forearms of four volunteers were treated with nine different parameter settings using a variable pulsewidth fractional Er:YAG 2940-nm laser with and without air cooling. The pain perception level was recorded on a 0-10 point scale (0=No pain; 10=Most severe pain). Three evaluations were made: during treatment, immediately after treatment, and 5 minutes after treatment. The same investigation was made on the right volar aspects of the same four volunteers using a short-pulse, random pattern, 3-mm spot, scanner-assisted Nd-YAG 1064-nm laser at 0.3 ms pulsewidth at seven different parameter settings. Clinical evaluations were made concerning erythema and edema 3 days after treatment, as well as pre-operative and 60 days postoperative skin texture plus color uniformity. Considering that the majority of cosmetic patients are willing to accept a relatively short and uneventful downtime (2-4 days according to a study we are presently conducting) and do prefer to limit their intra- and postoperative pain to a minimum, the best combination of clinical improvement matching these two important parameters were selected for our study. A treatment strategy combining two sequential passes of long-pulse Nd:YAG laser (Nd:YAG-LP) at 0.3 and 35 ms followed by two passes of long-pulse fractional Er:YAG laser (Er:YAG-FT) at 600 micros was designed to treat the facial regions of 10 volunteers affected by a combination of intrinsic (chrono-) and extrinsic (mostly photo-) aging. The pain perception level was recorded on a 0-10 scale (0=No pain; 10=Most severe pain). Three evaluations were made: during, immediately after, and 5 minutes after treatment. Erythema and edema were evaluated on a 0-3 point scale (0=No clinical signs; 3=Severe Clinical signs) at 7, 15 and 30 days. Improvements were determined by blind evaluation of photographs before, at 4 weeks, and at 8 weeks following treatments. Patient satisfaction was also evaluated on a 0-4 point scale (0=No satisfaction; 4=Excellent perceived improvement, 76-100%).

RESULTS: At the 30-day follow-up, participants had clinically detectable improvements of facial telangiectasias (1-25%), lentigines (25-50%), diffuse dyspigmentation (25-75%), fine lines (25-75%), and skin texture (25-75%). Clinical improvements were maintained at the 60-day follow-up, demonstrating the prolonged photothermally induced biological effect on skin function and texture. All volunteers confirmed their willingness to undergo the same procedure again to maintain and possibly improve their clinical results. Further clinical evaluations at 4 and 6 months will therefore be needed to identify a suitably convenient interval between two consecutive procedures.

CONCLUSION: The present study demonstrates objective and subjective improvements in fine lines, skin texture and dyspigmentation of facial skin after one sequential non-ablative and ablative laser treatment combining two different laser sources (Nd:YAG laser + Er:YAG laser).