Fractional, Nonablative Q-switched 1,064-nm Neodymium YAG Laser to Rejuvenate Photoaged Skin: A Pilot Case Series
November 2012 | Volume 11 | Issue 11 | Original Article | 1300 | Copyright © November 2012
Scientific research in the field of energy-based and light-based procedures made it possible to develop a very new and innovative
generation of lasers that combine the benefit of a nonablative and a fractional laser device, promising skin rejuvenation without
harming the epidermis. With this pilot case series, we performed one of the first systematic reports evaluating efficacy and safety of the
fractional, nonablative Q-switched 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser device in the treatment of rhytides
of the face, neck, and chest.
Seven healthy female subjects (mean ±standard deviation age, 53.8 ± 10.0 years) with visible signs of facial and neck skin aging
were treated with fractional, nonablative Q-switched 1,064-nm Nd:YAG laser device (Pixel QS Nd:YAG; Alma Lasers Ltd, Caesarea, Israel).
Treated areas were the face, including the periorbital and perioral regions (particularly the upper lip), neck, and chest. Treatments consisted
of 3 sessions at 2- to 4-week intervals. Follow-up was performed monthly following the final treatment. The Alexiades-Armenakas Comprehensive
Grading Scale of Skin Aging was employed to assess efficacy. Pain ratings were recorded by 10-point visual assessment scoring.
Employing the validated, quantitative grading scale for rhytides of the face and neck, a 0.29 grade improvement, or 11.3% improvement,
over baseline grade was observed in the 7-subject cohort that completed follow-up following a mean of approximately 2 treatments
at approximately 1-month follow-up. No pain and rapidly resolving minimal erythema were noted in all subjects during treatment.
The results of this pilot case series suggest that the treatment with the fractional, nonablative Q-switched 1,064-nm
Nd:YAG laser device significantly improves superficial rhytides. With its outstanding safety, it seems to be particularly suitable for the
treatment of sensitive areas, such as the periorbital region, lips, neck, and chest. The Q-switched Nd:YAG laser is a facile, safe, and fast
treatment for aesthetic skin rejuvenation.
J Drugs Dermatol.
Age-dependent modification is at the forefront of dermatological
research and cosmetic science.1,2 Besides
topical active ingredients and minimally invasive treatments,
eg, botulinum toxin or hyaluronic acid, laser devices
have expanded into numerous applications to treat a wide array
of skin conditions.2-4 Lasers direct a high-energy beam of a
single wavelength of coherent light into specific tissues, varying
in strength and the type of tissue they target.5,6 Corresponding
to its chronological development, two main laser classifications
have been established in the past regarding the degree
of ablation and recovery.7 Ablative laser systems, eg, CO2 and
erbium-doped yttrium aluminium garnet (Er:YAG) lasers, were
among the first resurfacing devices that were proven successful.
5,6 Although highly effective for rejuvenating photoaged
skin, the demand for less ablative treatments became evident
because of the high risk of unwanted side effects, eg, scarring,
infections, edema, or prolonged erythema, combined with a
long recovery period and painful treatment sessions.4 Based on
the concept of selective photothermolysis, presented by Anderson
and Parrish in the early 1980s, a second, less invasive treatment
modality was developed, promising good results while
preserving the epidermis.6,8 This nonablative technique was based on the principle of absorption of light and the different
chromophores in the skin, such as water, melanin, or hemoglobin,
resulting in selected damage limited to the target.4,6,8
In 2004, fractional photothermolysis was introduced which
treats only a fraction of the skin, unlike conventional ablative
and nonablative lasers.9 The prototype fractional, nonablative
device, a fractional 1,550-nm Er:YAG laser resulted in a combination
of epidermal coagulation for a resurfacing effect and
dermal denaturation for deeper remodeling repopulated by
fibroblast activity of neocollagenesis.4,5 A new generation of
fractional lasers followed, featuring high-power and fractionated
beams for nonablative skin remodeling and rejuvenation.10
Since microscopic columns of thermally denatured epidermis
and dermis are created and intervening zones of normal skin facilitate
wound rapid healing, fractional, nonablative treatments
have been associated with some perioperative discomfort and
a 2- to 3-day recovery period with erythema and mild edema.
A novel fractional, nonablative Q-switched neodymium-doped
YAG (Nd:YAG) 1,064-nm laser technology is presented here, which
combines the benefit of a nonablative and a fractional laser de-