|
New Orleans - "Three studies demonstrate the effectiveness of 1320nm Nd:YAG
nonablative laser therapy for acne scars, and neck and upper lip rhytides," Elizabeth
Faircloth Rostan, M.D. said at the annual meeting of the American Society for Laser
Medicine and Surgery.
Dr. Rostan added that the light-based treatment easily treats patients with darker
skin types.
"The improvements with the nonablative laser are more gradual in onset and
they are also typically less than what you would see with an ablative procedure,"
she said. Other disadvantages include the need for multiple treatments and a modest
degree of improvement when compared to ablative procedures.
However, results do indicate that the procedure results in the deposition of new
collagen. "Another advantage of this procedure is that it is bloodless," said Dr.
Rostan, Dermatology and Cosmetic Surgery Center of Charlotte. It results in minimal
side effects, usually consisting of erythema which disappears within an hour after
treatment.
For the dermatologist, this is a much easier procedure to learn, she said, as opposed
to resurfacing which is highly technique dependent, and
often requires multiple
modalities.
Nonablative laser technique
In the studies reported, the CoolTouch® 1320nm Nd:YAG laser with a cryogen cooling
device (CoolTouch, CoolTouch Corp.) was used. "The fluence was directed toward the
goal of obtaining the Tmax of 40° to 45° C," Dr. Rostan said. This is the maximum
effective temperature to be used with the CoolTouch. "This laser gives you a temperature
readback from the surface of the skin that allows you to appropriately gauge treatment
intensity," she added.
Two passes with the laser were delivered with the following settings: 28 to 36 J/cm2
and cryogen cooling duration of 20ms to 30ms with a laser delay of 30ms to 40ms.
Occasionally, topical anesthesia was needed. Pain during treatments is a possibility,
ranging anywhere from mild to moderate, Dr. Rostan said.
All studies showed clinical improvement as judged by subjective evaluations using
a quartile scale, deep rhytides, and elastosis. Optical profilometry measurements provided computer analysis of skin-surface impressions in neck and upper lip
studies.
Treatment of acne scars
Twelve patients with acne scars were given four treatments at four-week intervals.
Patients had Fitzpatrick skin types I to IV and all had stable acne.
One side of the face was treated then observed, and then the other side was treated.
Patients were followed for 12 weeks after the last treatment.
"This procedure is best for the patients with shallow or deep depressions, rather
than ice-pick scars, which almost always require some sort of excision procedure
to smooth down the sharp edges of the scar," said Dr. Rostan. However, there were
some patients with ice-pick scars who presented improvement, noted generally after
one or two treatments. "And patients continued to note improvement even after the
treatments were ended. This is evidence that collagen deposition is occurring."
The average improvement was about 25 percent, with some patients getting as high as 40 percent or 50 percent improvement. One disadvantage of nonablative treatment
of acne scars, Dr. Rostan said, is that the response is variable. Some patients
do very well, and some patients have only minimal degrees of improvement.
Treatment of the neck
"Because the skin of the neck is thin and has few appendigeal structures, there
is a greater risk of wound healing delays and scarring problems when you do laser
ablation," Dr. Rostan said.
In this split-neck study, one-half of the neck was treated, from the base of the
neck to jawline, using the other half as a control. The remaining side then was
treated.
There were 11 patients in this study. Treatments were delivered at three-week intervals
for a total of four treatments.
Biopsies were taken prior to treatment and at three months after the last treatment.
"There was a subjective judgment of improvement of an average of about 30 percent,"
Dr. Rostan said. Some patients did as well as 50 percent, with some showing
less than 25 percent improvement.
Biopsies indicated deposition of new collagen. "We did see some tightening, particularly
evident when we had treated only one side of the neck," Dr. Rostan said.
"With optical profilometry, we saw about a 15 percent reduction in scores, which
was significant," Dr. Rostan said. "We saw an average of 30 percent improvement
in the shadow score. "
Although the optical profilometry results are analyzed by computer, the creation
of the silicone impression is operator dependent and can affect the results
significantly, Dr. Rostan said.
"The best way to choose patients for nonablative subdermal remodeling of the neck
is to choose those who are mainly concerned about textural irregularities or
wrinkles," she said. For pigment abnormalities, including erythema, telangiectasia,
and hyperpigmentation. Dr. Rostan uses intense pulsed light treatments or a long
pulsed dye laser to treat the vascular components.
This study was undertaken to determine if there was an effect of treatment interval
and number of treatments for upper-lip skin therapy with the CoolTouch laser.
Thirty patients were divided into three groups. Group 1 received four treatments
every four weeks, Group 2 received six treatments every four weeks, and Group 3
received four treatments every six weeks.
Treatments were applied to the entire cutaneous upper lip and nasolabial folds.
"The results actually showed that improvements were very similar between the groups,"
Dr. Rostan said. The average improvement using a quartile scale was 31 percent for
Group 1, 26 percent for Group 2, and 25 percent for Group 3.
Group 1 demonstrated the greatest improvement in optical profilometry scores; however,
this group had a lower initial photoaging score compared to the other groups. The
improvement in optical profilometry scores may be explained by improved technique
in obtaining silicone impressions, Dr. Rostan said.
Dr. Rostan has no financial interest in CoolTouch. DT
|
List By Procedure
List By Technique
Request an Appointment
