CONCLUSIONS
The technology of the Clear + Brilliant NFDL system employs fractional photothermolysis to rejuvenate the skin, using 2 distinct handpieces each with a different wavelength, 1440 nm and 1927 nm. Compared with the 1440 nm wavelength handpiece, energy from the 1927 nm wavelength handpiece is more efficiently absorbed by water, producing shallower, wider MTZs. Regardless of the mechanism, data demonstrate that both lasers are effective in a variety of settings, are well tolerated, and provide high levels of patient satisfaction. The generally mild and transient nature of side effects reported posttreatment suggests limited downtime for patients.
Both lasers have demonstrated efficacy for rejuvenation of photodamaged facial skin, clinical improvement in skin tone, skin texture, fine lines, and dyschromia, and reduction of the number of detectable skin pores. Application of the 1927 nm wavelength handpiece improved skin appearance in conditions such as hyperpigmentation, melasma, and PIH, which have been challenging to treat safely and effectively with other laser approaches. The infrared energy generated by the Clear + Brilliant NFDL system targets water, rather than melanin, as a chromophore, so this system is appropriate for skin rejuvenation in Asian skin and for treatment of hyperpigmentation and PIH in skin of color, with a reduced risk of the AEs associated with other nonablative fractional treatments.
Future studies for the NFDL system should consider a split-face prospective study design, which would allow for comparative analysis. Given most published studies have limited followup to ≤3 months posttreatment, long-term durability of this therapy is unclear. Patients are encouraged to continue with maintenance treatments to ensure longevity of results and address future cumulative damage. This is especially true with clinical studies focusing on patients with melasma. When assessing combination treatment regimens, it can be difficult to ascertain whether the effect is synergistic or due to a single laser. Future studies with controls or split-face design would best further our knowledge on this modality. Other potential areas of research with the NFDL system include use of modified protocols, administered in combination with other devices or with topical agents (eg, tranexamic acid), and identification of optimal re-treatment strategies. Finally, additional studies would be valuable to expand the current dataset of the NFDL system for the treatment of facial pores, a common complaint among patients.
Both lasers have demonstrated efficacy for rejuvenation of photodamaged facial skin, clinical improvement in skin tone, skin texture, fine lines, and dyschromia, and reduction of the number of detectable skin pores. Application of the 1927 nm wavelength handpiece improved skin appearance in conditions such as hyperpigmentation, melasma, and PIH, which have been challenging to treat safely and effectively with other laser approaches. The infrared energy generated by the Clear + Brilliant NFDL system targets water, rather than melanin, as a chromophore, so this system is appropriate for skin rejuvenation in Asian skin and for treatment of hyperpigmentation and PIH in skin of color, with a reduced risk of the AEs associated with other nonablative fractional treatments.
Future studies for the NFDL system should consider a split-face prospective study design, which would allow for comparative analysis. Given most published studies have limited followup to ≤3 months posttreatment, long-term durability of this therapy is unclear. Patients are encouraged to continue with maintenance treatments to ensure longevity of results and address future cumulative damage. This is especially true with clinical studies focusing on patients with melasma. When assessing combination treatment regimens, it can be difficult to ascertain whether the effect is synergistic or due to a single laser. Future studies with controls or split-face design would best further our knowledge on this modality. Other potential areas of research with the NFDL system include use of modified protocols, administered in combination with other devices or with topical agents (eg, tranexamic acid), and identification of optimal re-treatment strategies. Finally, additional studies would be valuable to expand the current dataset of the NFDL system for the treatment of facial pores, a common complaint among patients.
DISCLOSURES
Paul M. Friedman has served on advisory boards for Allergan plc, Solta Medical, Inc., and Candela Corp, and as a consultant for Merz North America, Inc; has received grant funding from Sienna Biopharmaceuticals, Inc. and Candela Corp; has served as a principal investigator for Sienna Biopharmaceuticals, Inc.; and has received speaker honoraria from SkinCeuticals. Kristel D. Polder has served on advisory boards for Allergan plc, Solta Medical, Inc., L’Oréal USA and has served as a principal investigator for Galderma and Allergan plc.
Pooja Sodha reports being a consultant for Solta Medical, Inc.
Roy G Geronemus has served on advisory boards for Allergan plc, Candela Corp, Cearna Inc., Cynosure, Cytrellis Biosystems, Inc., Lutronic, Soliton Inc.; has served as an investigator for Allergan plc, Candela Corp, Cynosure, Cytrellis, Biosystems, Inc., Endo Pharmaceuticals Inc., Kerastem, Lutronic, New York Stem Cell Foundation, Sciton, Inc.; and is a stockholder of Cytrellis Biosystems, Inc.
Pooja Sodha reports being a consultant for Solta Medical, Inc.
Roy G Geronemus has served on advisory boards for Allergan plc, Candela Corp, Cearna Inc., Cynosure, Cytrellis Biosystems, Inc., Lutronic, Soliton Inc.; has served as an investigator for Allergan plc, Candela Corp, Cynosure, Cytrellis, Biosystems, Inc., Endo Pharmaceuticals Inc., Kerastem, Lutronic, New York Stem Cell Foundation, Sciton, Inc.; and is a stockholder of Cytrellis Biosystems, Inc.
ACKNOWLEDGMENTS
Technical editorial and medical writing assistance were
provided, under the direction of the authors, by Mary Beth
Moncrief, PhD, and Julie B. Stimmel, PhD, Synchrony Medical
Communications, LLC, West Chester, PA. Funding for this
assistance was provided by Solta Medical, Inc., Bothell, WA.
Solta Medical, Inc. reviewed the manuscript for scientific accuracy
only and did not actively contribute to the article content
or data interpretation.
REFERENCES
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2. Houreld NN. The use of lasers and light sources in skin rejuvenation. Clin Dermatol. 2019;37:358-364.
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4. Geronemus R, Du A, Yatskayer M, et al. Enhanced efficacy of a topical antioxidants regimen in conjunction with a home-use non-ablative fractional diode laser in photodamaged facial skin. J Cosmet Laser Ther. 2016;18:154- 161.
5. Polder KD, Stetler LD, Barba A, et al. Treatment with the Clear + Brilliant Perméa laser system: combined experience of 9 laser centres. Prime. 2013;September/October:21-31.
6. Fisher GH, Geronemus RG. Short-term side effects of fractional photothermolysis. Dermatol Surg. 2005;31:1245-1249.
7. Laubach HJ, Tannous Z, Anderson RR, et al. Skin responses to fractional photothermolysis. Lasers Surg Med. 2006;38:142-149. 8. Brauer J, Elford E, Loncaric A, et al. Treatment of photoaged skin using fractional non-ablative laser in combination with topical antioxidants [abstract]. Lasers Surg Med. 2012;44:68.
9. Woolery-Lloyd H, Viera MH, Valins W. Laser therapy in black skin. Facial Plast Surg Clin North Am. 2011;19:405-416.
10. Elford EL, Bedi VP. Enhanced skin permeability of ascorbic acid after CLEAR + BRILLIANT Perméa laser treatment. https://www.semanticscholar.org/ paper/Enhanced-Skin-Permeability-of-Ascorbic-Acid-after-%2B-Elford-Bedi/ 80b269896f9b19001c9c1b4a509c6e667824e8d4. 2012. Accessed January 6, 2020.
11. Elford EL, Oresajo C, Struck SK, et al. Enhanced skin permeabilty of topical aqueous antioxidant serum following 1927nm laser treatment [e-poster]. Presented at American Society for Laser Medicine and Surgery Annual Meeting; April 3-7, 2013; Boston, Massachusetts.
12. Elford EL, Struck SK, Bedi VP, et al. Enhanced skin permeability of topical aqueous antioxidant serum following 1927nm laser treatment [abstract]. Lasers Surg Med. 2013;45:278.
2. Houreld NN. The use of lasers and light sources in skin rejuvenation. Clin Dermatol. 2019;37:358-364.
3. Manstein D, Herron GS, Sink RK, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. `. 2004;34:426-438.
4. Geronemus R, Du A, Yatskayer M, et al. Enhanced efficacy of a topical antioxidants regimen in conjunction with a home-use non-ablative fractional diode laser in photodamaged facial skin. J Cosmet Laser Ther. 2016;18:154- 161.
5. Polder KD, Stetler LD, Barba A, et al. Treatment with the Clear + Brilliant Perméa laser system: combined experience of 9 laser centres. Prime. 2013;September/October:21-31.
6. Fisher GH, Geronemus RG. Short-term side effects of fractional photothermolysis. Dermatol Surg. 2005;31:1245-1249.
7. Laubach HJ, Tannous Z, Anderson RR, et al. Skin responses to fractional photothermolysis. Lasers Surg Med. 2006;38:142-149. 8. Brauer J, Elford E, Loncaric A, et al. Treatment of photoaged skin using fractional non-ablative laser in combination with topical antioxidants [abstract]. Lasers Surg Med. 2012;44:68.
9. Woolery-Lloyd H, Viera MH, Valins W. Laser therapy in black skin. Facial Plast Surg Clin North Am. 2011;19:405-416.
10. Elford EL, Bedi VP. Enhanced skin permeability of ascorbic acid after CLEAR + BRILLIANT Perméa laser treatment. https://www.semanticscholar.org/ paper/Enhanced-Skin-Permeability-of-Ascorbic-Acid-after-%2B-Elford-Bedi/ 80b269896f9b19001c9c1b4a509c6e667824e8d4. 2012. Accessed January 6, 2020.
11. Elford EL, Oresajo C, Struck SK, et al. Enhanced skin permeabilty of topical aqueous antioxidant serum following 1927nm laser treatment [e-poster]. Presented at American Society for Laser Medicine and Surgery Annual Meeting; April 3-7, 2013; Boston, Massachusetts.
12. Elford EL, Struck SK, Bedi VP, et al. Enhanced skin permeability of topical aqueous antioxidant serum following 1927nm laser treatment [abstract]. Lasers Surg Med. 2013;45:278.
