Neck and chest rejuvenation with fractional 1440 and 1927-nm low-powered diode laser.

OBJECTIVES: Ultraviolet light and infrared radiation exposure to the chest and neck can result in photoaging changes, such as rhytids, skin roughness, and dyschromia, which can be treated with nonablative fractionated lasers. The low-powered fractionated 1440 and 1927-nm diode lasers have been shown to safely reduce facial photodamage. This study was conducted to investigate the safety and efficacy of a low-powered 1440 and 1927-nm nonablative fractionated diode laser in addressing photoaging symptoms, such as rhytids, skin roughness, and dyschromia, of the neck and chest. METHODS: In a prospective, single-arm, nonrandomized study, a cohort of 24 adult female patients with photodamage to their neck and chest received four treatments to these areas, administered at 4-week intervals. Treatments consisted of four passes on high settings with the 1440 nm handpiece followed by four passes with the 1927 nm handpiece. Photographs were taken at each study visit. Study investigators graded wrinkle severity, texture, and mottled pigmentation of the treated area at baseline and follow-up visit, 3 months after the fourth treatment. Subjects also rated clinical improvement of their neck and chest, along with overall appearance. Blinded evaluators used baseline and follow-up photographs to quantify improvements of rhytids and hyperpigmentation of the neck and chest using a 6-point improvement scale. RESULTS: Of the original cohort, 20 subjects completed all four treatments and 3-month follow-ups. The mean rhytid scores improved by 0.7 ± 1.0 for both neck and chest. Meanwhile, texture scores improved by 1.2 ± 0.4 for the neck and 1.4 ± 0.7 for the chest, with pigment scores improving by 0.5 ± 0.6 for the neck and 0.67 ± 0.7 for the chest. Statistical analysis using paired t-tests, performed on all pre- and posttreatment scores, revealed significant differences (p < 0.05) in wrinkle severity, skin texture, and pigmentation of the neck and chest posttreatment. The degree of improvement was consistent for both the neck and chest areas. Blinded evaluators graded clinical improvements in rhytids and pigmentation at 0.6 ± 1.0 and 0.8 ± 1.2 respectively, corresponding to mild improvement of both neck and chest. CONCLUSIONS: A series of treatments with the nonablative low-energy fractional 1440 and 1927-nm diode laser appears to be safe and effective for improving rhytids, skin texture, and hyperpigmentation of the neck and chest.

Comparison of the 1064-nm picosecond laser with fractionated microlens array and 1565-nm non-ablative fractional laser for the treatment of enlarged pores: a randomized, split-face, controlled trial.

PURPOSE: This split-face randomized study compared the efficacy and safety between 1064-nm picosecond laser with fractionated microlens array (MLA) and 1565-nm nonablative fractional laser to treat enlarged pores. METHODS: Participants with enlarged facial pores were enrolled and underwent three consecutive sessions at 2-week intervals with either a 1064-nm picosecond laser with MLA or a 1565-nm nonablative fractional laser. Images were captured at each visit. Objective (pore number) and subjective assessments, including patient self-evaluations and quartile improvement scales, were used to evaluate the treatment efficacy. The pain levels and adverse effects were recorded at each subsequent visit. RESULTS: The participants were 3 men and 22 women with enlarged facial pores. At the initial and 2-month checkups after the last treatment, the pore numbers were significantly decreased bilaterally for both lasers. The respective quartile improvement scale scores for the 1064-nm picosecond and 1565-nm fractional lasers were 2.22 ± 1.06 and 2.14 ± 1.11, while those for patient self-assessment were 3.72 ± 0.74 and 3.68 ± 0.75. The pore number, quartile improvement scale score, and patients' self-assessments did not differ significantly between the two lasers. Treatment with the 1064-nm picosecond laser better reduced pain compared with the 1565-nm nonablative fractional laser (4.11 ± 1.33 vs. 4.83 ± 1.17). The occurrence of pigmentation did not differ significantly between the lasers. CONCLUSION: Both the 1064-nm picosecond laser with MLA and the 1565-nm nonablative fractional laser are viable options for treating enlarged pores, and showed comparable respective efficacies; however, the former was less likely to cause hyperpigmentation and was better tolerated.

Effectiveness and safety of nonablative fractional laser and infrared bipolar radiofrequency for treating periorbital wrinkles.

Non-ablative fractional laser (NAFL) and radiofrequency (RF) are popular for treating periorbital wrinkles owing to short downtime and low risk of side effects. To compare the effectiveness and safety of infrared bipolar radiofrequency (IR-RF) and NAFL, including 1540 nm Er: glass and 1927 nm thulium-doped laser, to determine the better option for clinical treatment of periorbital wrinkles. Twenty-seven patients assigned to 3 groups underwent split-face treatment. Two of the three treatments were randomly selected for patients in each group: IR-RF, 1540 nm Er: glass NAFL, and 1927 nm thulium-doped NAFL. Therapeutic outcomes were subjectively and objectively evaluated six months after the last treatment. Side effects and pain evaluations were conducted. Fitzpatrick wrinkle scores revealed no statistical difference for IR-RF, whereas the NAFL-treated sides exhibited significant improvements (p < .05). VISIA analysis of skin texture showed similar results. In IR-RF-treated sides, patients over 50 years old exhibited significant improvements compared with those below 50 (p < .05). The sample size was small. More objective evaluations like photometer measurements are required. NAFL is effective and safe for improving periorbital wrinkles, but IR-RF might be more suitable for elderly patients, particularly those with low pain tolerance.

Early Treatment Effects of Nonablative Fractional Lasers (NAFL) on Hypertrophic Scars in an Animal Model.

BACKGROUND AND OBJECTIVES: Recently, there have been several attempts to apply the laser therapy to hypertrophic scars (HTS). In particular, the fractional laser is in the spotlight for its usefulness in rapid wound healing and dermal remodeling. However, most previous studies have focused on the ablative fractional laser (AFL), and there are no studies on the mechanism of the nonablative fractional laser (NAFL) effect in HTS treatment. In this study, we aimed to evaluate the changes in histology and molecular chemistry to provide scientific evidence for the early treatment of HTS with NAFL. STUDY DESIGN/MATERIALS AND METHODS: A total of 40 hypertrophic burn scars were made on the abdomens of two female pigs. After epithelialization, the HTS were randomly subdivided into four groups-control, AFL, NAFL (low energy), and NAFL (high energy). Laser treatment was initiated 1 week after the crust fell and the epithelium became covered, and it was repeated for six sessions over an interval of 2 weeks. Five excisional biopsies were obtained for histologic analysis and biomarker assessment. RESULTS: Histologically, dermal remodeling with thin coil-shaped collagen fibers was observed in the NAFL groups. It also showed a significant increase of matrix metalloproteinase-2 (MMP-2) and Decorin at 16 weeks in an enzyme-linked immunosorbent assay. The reverse-transcription polymerase chain reaction analysis showed a tendency that high-pulse energy of NAFL led to higher messenger RNA expression than did the low-energy group. CONCLUSION: The NAFL-treated groups showed characteristic collagen re-arrangement and a significant increase in MMP-2 and Decorin. These molecular changes suggest that MMP-2 and Decorin play a significant role in dermal remodeling. Early NAFL treatment for HTS could be supported with both histological and molecular evidence. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Split-Sided Chest Study of Skin Rejuvenation Comparing Low-Energy, 1,927-nm Thulium Fractional Laser Treatment Prior to Photodynamic Therapy Versus Photodynamic Therapy Alone.

BACKGROUND AND OBJECTIVES: Treatment of photoaging and intrinsic aging of the chest, with the associated concerns of skin roughness, uneven pigmentation, laxity, atrophy, and telangiectasias, can be problematic because of the potential for worsened esthetic outcomes with existing treatments. This study assessed the efficacy and safety of using nonablative fractional laser therapy (FLT) pretreatment with photodynamic therapy (PDT) versus PDT alone for chest rejuvenation. STUDY DESIGN/MATERIALS AND METHODS: In a randomized, evaluator-blinded, split-sided study, adult female patients with photodamage to the chest received three treatment courses over an 8-week period with follow-up visits at Weeks 12 and 20. FLT was applied to one side of the chest, randomly assigned at baseline, followed by aminolevulinic acid-based PDT, delivered using a thermal, short incubation, broad area technique, to both sides of the chest. In-person and photographic assessments were conducted using five-point scales to evaluate outcomes including rhytides, pigmentation, skin texture, and telangiectasias. RESULTS: Eleven adults completed the study, of whom 11 had improved scores for rhytides and 10 had improved scores for skin texture at Week 20. There was no significant difference in any efficacy outcome between FLT and PDT and standard PDT alone. The severity of adverse events was rated significantly greater with the combined FLT-PDT treatment vs PDT alone. CONCLUSIONS: Significant improvements were observed vs baseline for both sides of the chest treated with FLT-PDT or standard PDT following three treatment sessions. No significant difference in efficacy was observed between treatment approaches, although adverse events were more severe on the FLT-pretreated side. This study was not registered as it qualified as a nonsignificant risk study. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Effective and lesion-free cutaneous influenza vaccination.

The current study details efficient lesion-free cutaneous vaccination via vaccine delivery into an array of micropores in the skin, instead of bolus injection at a single site. Such delivery effectively segregated vaccine-induced inflammation, resulting in rapid resolution of the inflammation, provided that distances between any two micropores were sufficient. When the inoculation site was treated by FDA-approved nonablative fractional laser (NAFL) before insertion of a PR8 model influenza vaccine-packaged, biodegradable microneedle array (MNs), mice displayed vigorous antigen-uptake, eliciting strong Th1-biased immunity. These animals were completely protected from homologous viral challenges, and fully or partially protected from heterologous H1N1 and H3N2 viral challenges, whereas mice receiving MNs alone suffered from severe illnesses or died of similar viral challenges. NAFL-mediated adjuvanicity was ascribed primarily to dsDNA and other "danger" signals released from laser-damaged skin cells. Thus, mice deficient in dsDNA-sensing pathway, but not Toll like receptor (TLR) or inflammasome pathways, showed poor responses to NAFL. Importantly, with this novel approach both mice and swine exhibited strong protective immunity without incurring any appreciable skin irritation, in sharp contrast to the overt skin irritation caused by intradermal injections. The effective lesion-free cutaneous vaccination merits further clinical studies.

Nonablative fractional laser-assisted daylight photodynamic therapy with topical methyl aminolevulinate for moderate to severe facial acne vulgaris: Results of a randomized and comparative study.

BACKGROUND: Photodynamic therapy (PDT) has been reported as an effective alternative treatment for patients with acne. PURPOSE: To evaluate the efficacy and safety of DL-PDT in moderate to severe acne and to compare outcomes with those of laser-assisted daylight photodynamic therapy. METHODS: Patients were randomly assigned to either a DL-PDT group (D group) or a fractional laser-assisted DL-PDT group (F group). The outcomes were assessed by measuring acne lesion counts and severity grade at 4, 8, 12, and 16 weeks after therapy commenced. RESULTS: Twenty-eight subjects completed the study. Compared with baseline, the mean inflammatory lesion counts significantly decreased by 36.0% in the D group and 51.8% in the F group at 8 weeks (P<.001). The mean acne severity grades in both groups significantly decreased starting at 4 weeks (P=.012), and the beneficial effects lasted 16 weeks. CONCLUSION: DL-PDT with MAL shows clinically good responses to inflammatory lesions and is well tolerated in patients with moderate to severe acne.

Evaluation of nonablative fractional laser treatment in scar reduction.

Fractional lasers have been used for the improvement of scar tissue in the recent years but there has not been extensive research on their impact. The purpose of this study was to evaluate the efficacy of nonablative fractional laser (NAFL) on acne, burn, and surgery/traumatic scar. The scars were also categorized as atrophic, hypertrophic, and keloid, and treatment efficacy was investigated accordingly. This is a retrospective, single-center study. Scar tissues were treated using a nonablative fractional 1550-nm Erbium glass laser in high-energy parameters at 4-week interval for 4-8 sessions. The scar regression score (SRS) was used to determine the decrease in scar appearance. Forty-six patients with acne (n:18), burn (n:13), or surgery/traumatic (n:15) scar were included. The number of sessions was higher for burn patients while SRS in burn patients was lower than in patients with acne or a surgical/traumatic scar. Evaluation according to scar types showed that atrophic scars had a significantly better response to NAFL treatment. This study indicates that NAFL treatment with the high-energy parameters has better outcomes in atrophic acne scars, while the success rate is considerably low in post-burn and keloid scars.

A case of successfully treated recalcitrant EGFR inhibitor-induced acneiform eruption following non-ablative fractional laser.

Epidermal growth factor receptor (EGFR) inhibitor, a targeted therapy in the field of oncology, is a new drugs suggested for the cause of acneiform eruptions. The unresponsiveness to conventional acne therapy is a pivotal reason of seeking alternatives to treat drug-induced acneiform eruptions. A 30-year-old female treated with cetuximab, EGFR inhibitor presented with numerous sized erythematous papules and pustules on her face. All responses of oral medications and topical application were poor. She was treated with two passes of non-ablative 1550 nm fractional erbium glass laser with topical clindamycin. After three laser sessions, the skin lesions improved dramatically without any side effects. There is currently no single effective treatment for acneiform eruption. This report shed light on the possibility that non-ablative fractional laser can be an alternative for recalcitrant drug-induced acneiform eruptions.

Treatment of erythematous acne scars using 595-nm pulsed dye laser combined with 1565-nm ResurFX nonablative fractional laser.

BACKGROUND: Acne vulgaris is a common inflammatory disease associated with various sequelae after skin lesion remission. Acne erythema has been considered simple erythema or a vascular lesion; however, because the understanding of this disease has improved, acne erythema is currently considered an early scar with erythematous components. AIMS: This study evaluated the efficacy of using both a 595-nm pulsed dye laser (PDL) and 1565-nm nonablative fractional laser (NAFL) for the treatment of erythematous scars caused by acne. METHODS: Ninety patients with acne scars were equally randomized to two groups. Group A (n = 45) received treatment with the NAFL. Group B (n = 45) received treatment with the PDL and NAFL. Each patient underwent one treatment session and 4 weeks of follow-up. RESULTS: Qualitative (χ2 = 12.415; p < 0.05) and quantitative (t = 2.675; p < 0.05) scores of Groups A and B were determined using a global scarring grading system and exhibited statistically significant differences. The quantitative score of Group A was higher than that of Group B (6.67 ± 3.46 vs. 4.98 ± 2.44). The erythema areas of the groups differed significantly after treatment, with Group B exhibiting more notable score improvements (5.00 [3.10, 7.10] vs. 2.80 [1.65, 4.60]; Z = 3.072; p < 0.05). The erythema regression rate of Group B (88.9%) was significantly higher than that of Group A (66.7%) (χ2 = 20.295; p < 0.001). Adverse events, including redness and swelling (86.6%), scabbing (78.8%), and purpura (36.6%), occurred within 7 days for 86.6% of patients. CONCLUSIONS: The combined use of the PDL and NAFL is safe and effective for erythematous acne scars.

Efficacy and safety of 1565-nm nonablative fractional laser combined with mucopolysaccharide polysulfate cream for erythematous acne scars.

PURPOSE: To evaluate the efficacy and safety of 1565-nm nonablative fractional laser (NAFL) combined with mucopolysaccharide polysulfate (MPS) cream in the treatment of erythematous acne scars. METHODS: A total of 28 subjects with erythematous acne scars from June 2021 to April 2022 were enrolled. One side of each subject's face was randomly assigned to be treated with 1565-nm NAFL (at 2 sessions with four-week intervals) combined with MPS cream (twice daily) for 8 weeks, and the other side with 1565-nm NAFL combined with placebo cream. CBS® images and parameters, dermoscopic images and the quantitative data processed by ImageJ software, and quantitative global scarring grading system (GSS) score were obtained at baseline and after treatment. Subjects' satisfaction assessment was performed after treatment. Adverse events were recorded during treatment. RESULTS: In CBS® parameters, the red area, red area concentration, and smoothness were improved more significantly on the 1565-nm NAFL combined with MPS cream side than on the 1565-nm NAFL combined with placebo cream side after treatment (p = 0.015, p = 0.013, and p = 0.021). For dermoscopy, both scar area and scar redness achieved a significantly greater percentage of improvement on the side of 1565-nm NAFL combined with MPS cream than the side of 1565-nm NAFL combined with placebo cream after treatment (p = 0.005 and p = 0.041). The reduction of quantitative GSS score and Subjects' satisfaction assessment were similarly superior on the 1565-nm NAFL combined with MPS cream side. Temporary erythema was experienced by all subjects after each 1565-nm NAFL treatment. No subject reported intolerance or allergy to the cream during follow-up. CONCLUSIONS: The combined application of 1565-nm NAFL and MPS cream could be an effective and safe treatment for erythematous acne scars. ImageJ software enables quantitative evaluation of dermoscopic images of acne scars.

Nonablative fractional laser therapy for treatment of actinic keratosis with 3-months follow-up.

BACKGROUND: Actinic keratosis (AK) is a common skin disorder that is treated with different treatment modalities. AIMS: The aim of this study was to assess the therapeutic effect of a 1540-nm nonablative fractional laser on the AK. METHODS: Ten patients with 31 AK were included in the study according to the inclusion and exclusion criteria. Treatment with nonablative fractional laser (1540 nm) 3 times at 4 weeks intervals in a noncontact mode was applied. Clinical severity was assessed at each session and 3 months after the last session. It is pertinent to mention that the patients were also involved in the assessment of improvement. RESULTS: The results of present study showed that in comparison to the baseline, 3-session AK therapy with nonablative fractional laser significantly not only improved the AK severity by 79%, but also reduced the AK counts (from 31 to 17). On the other hand, the patients consented to the therapeutic effect. CONCLUSION: According to the obtained results and available studies, it seems that therapy with a 1540-nm nonablative fractional laser could be considered as a safe and effective alternative therapeutic option for the treatment of AK.

Treatment of alopecia areata with nonablative fractional laser combined with topical minoxidil.

BACKGROUND: Alopecia areata (AA) is a relatively common dermatosis with the sudden burst of hair loss on the scalp and other hair-bearing regions. However, because of high relapse and side effects, no satisfactory therapy has been widely accepted. OBJECTIVE: To observe the efficiency and safety of the combination therapy of a nonablative fractional (NAF) laser and topical minoxidil for AA. METHODS: Eight Chinese AA patients were included in this study. These patients received 10 treatments every two weeks. At every time, the subject was given 10 to 15 mJ of energy with a total intensity of 300 spots/cm2 . After the laser treatment, a topical 5% minoxidil tincture was immediately applied twice daily and continued until the final laser treatment. RESULTS: Hair regrowth was observed 1-2 months after treatment. There was complete regrowth in 2 patients, and the lesions of 2 children with alopecia universalis were covered with 30% and 50% regrowth, respectively. All patients except 1 had no relapse at the 1-year follow-up examination. CONCLUSION: The combination of nonablative laser and topical minoxidil may be a good alternative therapy for AA patients, including alopecia totalis and alopecia universalis, without systemic and local side effects.

Comparison of four different lasers for acne scars: Resurfacing and fractional lasers.

BACKGROUND: Acne scars are common and cause cosmetic problems. There is a multitude of treatment options for acne scars, including dermabrasion, chemical peeling, and fillers, but the advent of laser technology has greatly improved the treatment of acne scars. Although several laser systems are available, studies comparing their efficacy are limited. This study compares the results of treatments using resurfacing (carbon dioxide, CO2; erbium-doped yttrium aluminum garnet, Er:YAG) versus fractional (nonablative fractional laser, NAFL; ablative fractional laser, AFL) lasers. METHODS: A retrospective photographic analysis of 58 patients who underwent laser treatment for facial atrophic acne scars was performed. Clinical improvement was assessed by six blinded investigators with a scale graded from 0 to 10. Adverse events were also noted. RESULTS: Mean improvement scores of the CO2, Er:YAG, NAFL, and AFL groups were 6.0, 5.8, 2.2, and 5.2, respectively. The NAFL group showed a significantly lower score than the other groups. The mean number of treatments was significantly greater in the fractional laser groups than in the resurfacing laser groups. The resurfacing laser groups had a prolonged recovery period and high risk of complications. The Er:YAG laser caused less erythema or pigmentation compared to the CO2 laser. CONCLUSIONS: Although the CO2 laser, Er:YAG laser, and AFL improved the acne scars, the CO2 laser had a greater downtime. Three consecutive AFL treatments are as effective as a single treatment with resurfacing lasers, with shorter social downtime periods and less adverse effects.

Nonablative fractional laser treatment for the skin in the eye area - clinical and cutometric analysis.

OBJECTIVE: The purpose of the research was to evaluate skin elasticity and reduction in the aging eye area using a 1410-nm nonablative fractional laser treatment, cutometric measurements and photographic documentation. MATERIAL AND METHODS: This study included 24 patients (21 women, three men), aged 33-50 years (the average age was 44.6) with Fitzpatrick skin type II and III. They received five successive treatment sessions with a 1410-nm nonablative fractional laser in 2-week intervals. Biomechanical properties of the skin were measured by using Cutometer (Courage+Khazaka electronic). Measurements of skin elasticity were made in three places of the eye area. A photographic documentation was used to compare changes after the series of treatment sessions. Additionally, the patients filled in a survey in which they were asked to make a self-evaluation of the administered procedure. RESULTS: Cutometric analysis showed a significant improvement of skin elasticity. Changes in the measurements of R2 and R6 parameters indicate that the statistical significance level is mostly P < 0.0001 for the differences in the measurements. The analysis of clinical results of the therapy, using photographic documentation, showed a 47% decrease in the quantity and depth of wrinkles in the eye area. CONCLUSIONS: A 1410-nm nonablative fractional laser treatment seems to be an effective method aiming at reducing wrinkles in the eye area and improving tightness. Cutometric measurements provide invaluable help in the objective evaluation of the anti-aging treatment and the photographic documentation is an excellent addition to the clinical analysis.