Fractional deep dermal ablation induces tissue tightening.

BACKGROUND AND OBJECTIVE: Due to the significant risk profile associated with traditional ablative resurfacing, a safer and less invasive treatment approach known as fractional deep dermal ablation (FDDA) was recently developed. We report the results of the first clinical investigation of this modality for treatment of photodamaged skin. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four subjects received treatments on the inner forearm with a prototype fractional CO(2) laser device (Reliant Technologies Inc., Mountain View, CA) at settings of 5-40 mJ/MTZ and 400 MTZ/cm(2). Clinical and histological effects were assessed by study investigators 1 week, 1 month, and 3 months following treatment. Thirty subjects were then enrolled in a multi-center study for treatment of photodamage using the same device. Subjects received 1-2 treatments on the face and neck, with energies ranging from 10 to 40 mJ/MTZ and densities ranging from 400 to 1,200 MTZ/cm(2). Study investigators assessed severity of post-treatment responses during follow-up visits 48 hours, 1 week, 1 month, and 3 months following treatment. Using a standard quartile improvement scale (0-4), subjects and investigators assessed improvement in rhytides, pigmentation, texture, laxity and overall appearance 1 and 3 months post-treatment. RESULTS: Clinical and histologic results demonstrated that fractional delivery of a 10,600 nm CO(2) laser source offers an improved safety profile with respect to traditional ablative resurfacing, while still effectively resurfacing epidermal and dermal tissue. Forearm and facial treatments were well-tolerated with no serious adverse events observed. Eighty-three percent of subjects exhibited moderate or better overall improvement (50-100%), according to study investigator quartile scoring. CONCLUSIONS: FDDA treatment is a safe and promising new approach for resurfacing of epidermal and deep dermal tissue targets.

Evaluation of a novel fractional resurfacing device for treatment of acne scarring.

BACKGROUND AND OBJECTIVE: Pulsed carbon dioxide (CO(2)) laser devices are considered highly effective treatment options for skin resurfacing. However, the high risk for significant treatment complications following CO(2) resurfacing has warranted the development of new treatment modalities. The concept of fractional photothermolysis was developed to address the shortcomings of ablative and non-ablative device modalities. This report evaluates a fractional approach to CO(2) laser resurfacing for the treatment of moderate to severe acne scarring. The primary endpoint of the study was the overall improvement in the appearance of acne scarring. STUDY DESIGN/MATERIALS AND METHODS: Thirty subjects, with moderate to severe acne scarring, underwent up to three treatments with an FDA IDE and IRB approved 10,600 nm fractional CO(2) laser system. All subjects were Fitzpatrick skin types I-V and 18-75 years of age. Treatment parameters ranged from 20 to 100 mJ with total densities of 600-1,600 MTZ/cm(2). Improvement of acne scarring was evaluated at 1 and 3 months post-treatment. RESULTS: Twenty-three out of 25 subjects sustained clinical improvement in the appearance of acne scarring at the 3-month follow-up visits according to study investigator quartile improvement scoring. Subjects also had improvement in their overall appearance, including pigmentation and rhytides. Serosanguinous oozing resolved within 24-48 hours following treatment. All subjects had transient erythema, which resolved in the majority of subjects within 1-3 months. Post-operative downtime was significantly decreased compared to traditional ablative resurfacing. No serious complications were reported. CONCLUSION: Fractional deep dermal ablation improves moderate to severe acne scarring. The added benefit is a considerable reduction both in downtime and risk of complications when compared to traditional CO(2) ablative resurfacing techniques.