A Multiplexed 1,440 and 1,320 nm Laser for Treatment of Chronic Photodamage
November 2011 | Volume 10 | Issue 11 | Original Article | 1266 | Copyright © November 2011
Eric F. Bernstein MD
AbstractBackground and Objectives: The purpose of this study is to quantify the safety and effectiveness of a multiplexed 1,440 and 1,320 nm fractionated laser for the treatment of chronic photodamage.
Study Design: A total of twenty subjects with chronic photodamage were enrolled in this study. Subjects received a maximum of four full-face treatments at an average fluence of 9.5 J/cm2 at 1,320 nm and 2 J/cm2 at 1,450 nm, delivered sequentially using forced-air cooling, at monthly intervals. Digital photographs were taken two months following the final treatment and compared to pre-treatment photographs by two blinded physician observers.
Results: Improvement in photodamage, overall appearance, wrinkles, hyper-pigmentation, enlarged pores, and sagging skin was rated by blinded physician evaluation of digital photographs as being in the 25-50 percent range. Subjective ratings averaged improved for all criteria that were evaluated, including wrinkles, enlarged pores, redness, sagging skin and hyper-pigmentation.
Conclusions: The multiplexed 1,320 nm and 1,440 nm fractionated laser improves cuta/neous photodamage as assessed by objective and subjective criteria.
J Drugs Dermatol. 2011;10(11):1266-1270.
Chronic sun damage results in most of the changes we associate with an aged appearance.1-4 This can easily be shown by comparing sun-protected to sun-damaged skin in the same individual. The five key features of photoaging are fine lines and wrinkles, enlarged pores, sagging skin, telangiectasias, and pigmentary alterations. Lasers have been instrumental for improving photodamaged skin. Numerous wavelengths have been used to treat the myriad symptoms of cutaneous photodamage. Lasers that target hemoglobin have been used to remove sun-induced erythema, while also stimulating dermal remodeling to improve fine lines and wrinkles and enlarged pores.5-9 In addition, lasers, and other light sources that target pigment have been used to remove pigmentary alterations, while also improving the overall appearance of treated skin.10-13 To specifically target skin without relying on melanin pigment or hemoglobin as a target, wavelengths predominantly absorbed by water have been used. The goldstandard lasers for improving cutaneous photodamage are the ultrapulsed carbon dioxide lasers.14-15 These lasers remove the epidermis and superficial dermis resulting in an open wound that heals over 1-2 weeks following treatment. Side effects, including permanent hypo-pigmentation and prolonged erythema post-treatment lasting three months or more, have limited the use of these lasers in recent years despite the dramatic improvement seen following treatment.14-15
In an attempt to derive results similar to laser resurfacing with a reduced side-effect profile, fractionated lasers were developed that make tiny wounds in the skin, removing and/or damaging only a fraction of the photodamaged skin at any one treatment session, with normal, intact skin in between the zones of damage. It was theorized that fractionated lasers which treat only a portion of the skin in a given treatment area would produce similar results to laser resurfacing utilizing multiple partial treatments to completely target the skin in a given area. While five 20% treatments might equate to one 100% treatment when treating an inanimate object like wood, skin is a living tissue and responds very differently when healing an open wound versus multiple small wounds surrounded by zones of normal tissue. Although fractionated treatments are capable of producing excellent results, the healing is qualitatively different than that which occurs following ablative carbon dioxide or Er:YAG laser resurfacing. Still, the trade off of no or less downtime with more moderate results is ideal for most patients. In this study, we investigate a multiplexed 1,440/1,320 nm fractionated laser as it is currently