system employs higher power that is delivered through one handpiece (Table 1). The 1927 nm wavelength handpiece of the NFDL system produces an elliptical- to rectangular-shaped beam (Figure 1A) with an aspect ratio of about 2.5:1, and has a fixed spot size of between 110 and 180 μm (calculated by circle of equivalent area). The 1927 nm laser of the 1550 nm erbiumdoped and 1927 nm thulium laser system produces a circular beam (Figures 1B and 1C) with a variable beam size, ranging from 85 to 620 μm. In addition, the higher powered 1550 nm erbium-doped and 1927 nm thulium laser system offers variable energy settings, in contrast to the maximum 5 mJ energy level of the 1927 nm wavelength handpiece of the NFDL system (Table 1). When using the NFDL system, topical anesthesia is optional, though recommended, and downtime for the patient is minimal.
Patient satisfaction has been high with the 1927 nm wavelength handpiece of the NFDL system, and treatment has been well tolerated. In a study of 78 patients with Fitzpatrick skin type I–V and mild to moderate photodamage and/or dyspigmentation, patients received treatment every 2 weeks for a total of 6 treatments with the 1927 nm wavelength handpiece (4 passes; 5 mJ/pulse; treatment coverage: low, 2.5%; medium, 3.75%; high, 5%), combined with a topical serum containing 15% L-ascorbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid.5 Patients rated treatment satisfaction using a 5-point scale (1 = very satisfied; 5 = very dissatisfied). Most patients (86%) reported high satisfaction (“satisfied†to “very satisfiedâ€) with treatment at 2 weeks posttreatment (mean score, 1.7 ± 0.7). Patients observed improvement in skin texture, skin tone, and dyschromia. Furthermore, the treatment regimen was well tolerated, with transient erythema and edema lasting ≤24 hours; on an 11-point pain scale (0 = no pain; 10 = worst pain), the mean ± SD pain score immediately posttreatment across 6 treatment visits was 3.6 ± 1.7.
The objective of this manuscript is to provide an overview of the 1440 nm and 1927 nm Clear + Brilliant laser system and discuss current trends and future directions for its use.
Fractional Photothermolysis Promotes Skin Rejuvenation
Fractional photothermolysis as a mechanism for skin rejuvenation generates an array of microscopic areas of thermal injury to the skin (ie, microscopic treatment zones [MTZs]).3,6 These zones of thermal injury induce focal dermal wounds while sparing surrounding tissue.3 In a study of 12 individuals, a single treatment was performed on the forearm using a 1500 nm
