Evaluation of a Low Energy, Low Density, Non-Ablative Fractional 1927nm Wavelength Laser for Facial Skin Resurfacing
November 2015 | Volume 14 | Issue 11 | Original Article | 1262 | Copyright © 2015
Jeremy A. Brauer MD,a,b Hamad Alabdulrazzaq MBChB,a Yoon-Soo Cindy Bae MD,a,b
and Roy G. Geronemus MDa,b
aLaser & Skin Surgery Center of New York, New York, NY
bRonald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York, NY
OBJECTIVE: We investigated the safety, tolerability and efficacy of a low energy low density, non-ablative fractional 1,927-nm laser in the treatment of facial photodamage, melasma, and post inflammatory hyperpigmentation.
DESIGN: Prospective non-randomized trial.
SETTING: Single center, private practice with a dedicated research department.
PARTICIPANTS: Subjects with clinically diagnosed facial photodamage, melasma, or post inflammatory hyperpigmentation
INTERVENTIONS: Subjects received four to six treatments at 14-day intervals (+/- 3days) with a low energy low density non-ablative fractional 1,927-nm laser (Solta Hayward, CA) with an energy level of 5 mJ, and density coverage of either 5%, 7.5%, or 10%, with a total of up to 8 passes.
MAIN OUTCOME AND MEASURES: Blinded assessment of clinical photos for overall improvement at one and three months post final treatment. Investigator improvement scores, and subject pain and satisfaction scores for overall improvement were recorded as well.
RESULTS: We enrolled 23 subjects, average age 45.0 years (range, 25-64 years), 22 with Fitzpatrick Skin Types I-IV and 1 with Type VI, with facial photodamage, melasma, or post inflammatory hyperpigmentation. Approximately 55% of subjects reported marked to very significant improvement at one and three months post final treatment. Blinded assessment of photography of 20 subjects revealed an average of moderate improvement at one-month follow up and mild to moderate improvement at three months. Average subject pain score was 3.4/10 during treatment.
CONCLUSIONS AND RELEVANCE: Favorable outcomes were demonstrated using the low energy low density, non-ablative fractional 1,927-nm laser in facial resurfacing for photodamage, melasma, and post inflammatory hyperpigmentation. Results were maintained at the 3-month follow up, as demonstrated by investigator and subject assessments, as well as blinded evaluations by three independent dermatologists utilizing photographs obtained from a standardized facial imaging device.
J Drugs Dermatol. 2015;14(11):1262-1267.
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Chronic ultraviolet radiation from sun exposure results in photoaging, with the development of fine rhytids, uneven pigment alteration, lentigines, telangiectasia, actinic keratosis, skin atrophy, and loss of dermal elasticity.1 Though induced by other etiologies as well, ultraviolet light may also exacerbate skin conditions such as melasma and post inflammatory hyperpigmentation (PIH). There are multiple treatment options currently available that can help control or reverse these processes, including preventative measures with the use of photoprotection, and a variety of topical products that encompass topical retinoids, hydroquinones, and antioxidants.2-4 Chemical peels and light based technologies, including intense pulsed light and various laser procedures, have previously been shown to be effective in facial rejuvenation and can selectively be used in the management of melasma and PIH.3-10 Ablative laser treatments though highly effective, have a long downtime and can result in significant adverse reactions including scarring, hyperpigmentation, and delayed onset hypopigmentation, limiting its use in certain skin photo types. Non-ablative laser treatments, have a better safety profile, however the efficacy is limited when compared to ablative lasers for the treatment of photodamage.10
Fractional photothermolysis delivers laser energy to the skin with areas of sparing resulting in precise and highly controlled zones of injury, or microthermal treatment zones (MTZs).11 With the sparing of epidermal destruction, healing is more rapid and patients experience a shorter downtime when compared to fully ablative laser procedures. Subsequent to the formation of the MTZs, wound healing mechanisms ensue which stimulate epidermal exfoliation of both the treated and spared skin.12 By utilizing this technique, fractional lasers could result in effective