Hybrid Fractional Laser: A Multi-Center Trial on the Safety and Efficacy for Photorejuvenation
November 2018 | Volume 17 | Issue 11 | Original Article | 1164 | Copyright © 2018
Jill S. Waibel MD,a Jason Pozner MD,b Christopher Robb MD,c Elizabeth Tanzi MDd
aMiami Dermatology and Laser Institute, Miami, FL bSanctuary Plastic Surgery, Boca Raton, FL cSkin and Allergy Center, Spring Hill, TN dCapital Laser and Skin Care, Chevy Chase, MD
BACKGROUND: Laser skin resurfacing has continued to evolve over the past two decades. One of the most recent advances included a hybrid fractional laser resurfacing system that can sequentially utilize two wavelengths in its delivery, non-ablative coagulation with 1470 nm, and ablative vaporization with 2940 nm. The 1470 nm laser wavelength is absorbed by water, which is ideal for creating controlled zones of coagulation to chosen depths into the dermis up to 700 micrometers. The 2940 nm laser wavelength has a large water absorption coefficient, which results in precise ablation as desired in the epidermis up to 110 micrometers. This combination allows for fractionated non-ablative and ablative skin resurfacing simultaneously resulting in a cosmetic improvement in pigmentation, tone, texture of skin as well as other effects of photoaging. METHODS: Open-label prospective, multi-center study in which 34 female subjects were enrolled with Fitzpatrick skin types I-IV, mean age of 52 ± 14 years. Each subject underwent two treatments, spaced 4-6 weeks apart. Follow up visits at 1 week, 2 weeks, and 1, 2, and 3 months after the first treatment. Photographs, numeric pain scores during treatment, and subject satisfaction survey questionnaires were evaluated. Photographs were analyzed by six blinded evaluators. The primary endpoint was to evaluate safety and efficacy of hybrid laser treatments for photodamage and dyschromia. The secondary endpoints included evaluating the tolerability of the treatment using the Wong Baker Face scale and patient satisfaction survey results. RESULTS: Of the 29 subjects completing the study, 80% showed significant skin improvement on photographic analysis. Average numeric pain score was a 4 on a 0-10 scale. Survey results showed 100% satisfaction with treatment and achieved results. Two patients experienced post-inflammatory hyperpigmentation that resolved within 90 days. No other adverse events were reported. CONCLUSION: The non-ablative and ablative hybrid fractional laser can be used to safely and efficaciously treat photodamaged skin with high patient satisfaction and minimal adverse events. J Drugs Dermatol. 2018;17(11):1164-1168.
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Laser skin resurfacing is a popular procedure to rejuvenate photoaged skin.1 The first reported use of a laser for skin resurfacing was in 1996 with a pulsed carbon dioxide (CO2) laser.2 Subsequent development of the erbiumdoped yttrium aluminum garnet (Er:YAG) laser produced ablation with less thermal damage resulting in fewer adverse events versus CO2 laser.3 However, ablative laser resurfacing necessitates a period of downtime during healing and re-epithelialization. 1 More than a decade ago, non-ablative lasers, and intense pulsed light systems were introduced as viable alternatives, to increase safety and decrease post-operative downtime.4 However, these devices failed to deliver the impressive results seen after fully ablative laser skin resurfacing.Fractional ablative and non-ablative lasers were next introduced as a means of decreasing post-operative downtime while maintaining the high level of cosmetic benefits of ablative procedures.1-5 While these treatments can deliver satisfactory results, patients and physicians continue to seek additional cosmetic benefits coupled with less recovery time. A novel hybrid fractional laser allows for the simultaneous delivery of a non-ablative and ablative fractional wavelength in a single pulse. The 1470nm non-ablative wavelength for coagulation is tunable between 100 and 700 microns and optimally targets epidermal and dermal pigmented lesions. The 2940nm wavelength for ablation is tunable between 0 and 100 microns to remove stratum corneum or epidermis, aids in healing, and improves the cosmetic result. Additionally, this novel hybrid fractional laser has dynamic thermal optimization (DTO) to continually measure the temperature of the skin and automatically adjust energy density and pulse width to ensure the specified parameters of treatment are delivered in a reliable and uniform fashion. A speed sensor is also located within the handpiece that adapts to the operator and regulates the scanning speed to deliver a consistent treatment.A small case series has shown that the combination of fractional non-ablative and fractional ablative treatments can improve the appearance of wrinkles and pigment similar to outcomes