Treatment of Photoaging with a Very Superficial Er:YAG Laser in Combination with a Broadband Light Source
November 2007 | Volume 6 | Issue 11 | Original Article | 1114 | Copyright © November 2007
Alexander L. Berlin MD, Mussarrat Hussain MD, Robert Phelps MD, David J. Goldberg MD
Background and Objective: Studies documenting improvement following combined laser and light-based devices are
needed. The objective of this study was to evaluate clinical, histological, and ultrastructural changes in photodamaged
facial skin following sequential treatment with ablative superficial erbium:YAG (Er:YAG) laser peels and nonablative
intense pulsed light, or broadband light (BBL), treatments.
Study Design/Materials and Methods: Fifteen subjects with photodamaged facial skin and Fitzpatrick skin types I to III
underwent 3 monthly treatments with the Profile™ system (Sciton, Inc, Palo Alto, CA) utilizing very superficial
MicroLaserPeel™ settings of 2.5 to 5.0 J/cm2 and BBL™ settings of 515-, 560-, or 590-nm filters, 10-msec pulse duration,
and fluences of 12 J/cm2. Five subjects underwent pre- and post-treatment postauricular skin biopsies for evaluation of
treatment-induced light and electron microscopic changes.
Results: Twelve subjects completed the study. Both blinded evaluator and subject assessment of clinical changes documented
significant improvement in photodamaged skin, with the greatest improvement achieved in overall appearance
and epidermal dyspigmentation. These results were largely maintained at 3 months following the last treatment. Light
microscopy showed changes in the epidermis, collagen, and elastic fibers consistent with a wound repair mechanism to
the depth of 250 to 350 microns. Electron microscopy revealed a slight decrease in the average collagen fiber thickness,
pointing to an increase in type III collagen.
Conclusion: A protocol utilizing multiple combined superficial Er:YAG ablative treatments and nonablative BBL treatments
lead to a significant improvement in the clinical signs of photodamaged skin, with histological and ultrastructural
evidence of new collagen formation.