Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN Vanderbilt University School of Nursing, Nashville, TN Meharry Medical College, School of Medicine; Huashan Hospital, Fudan University, Shanghai, China; The First Hospital of China Medical University, Shenyang, China Guangdong Provincial People’s Hospital, Guangzhou, China First People’s Hospital of Foshan, Guangzhou, China The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China The People’s Hospital of Hunan Province, Changsha, Hunan Province, China
(P less than 0.01) at one month, one year, and ve years as compared to baselines. An example is shown in Figure 2. Fractional laser skin resurfacing for hypertrophic scars also has become a popular treatment in recent years, thanks to the work of Waibel and Beer, who rst reported on treating these lesions successfully.5 Tan et al6 have also reported on the use of fractional CO2 lasers in the treatment of scars and have shown that with fractional CO2 lasers, treating these lesions can be accomplished. A case is shown in Figure 3. Fractional EBDs are not limited to lasers and recent work with radiofrequency (RF) energy has shown that these too can be used successfully to treat wrinkles and rhytids, as well as acne and traumatic scars. Work by Hruza et al7 and Gold and Biron8 showed that pin-based delivery of bipolar RF energy into the skin would have an effect on wrinkle and scars. RF energy is color-blind and therefore useful in all skin types with minimal risks of pigmentary concerns following treatment. What made these devices popular and makes them continue to be popular today is that they all work by having minimal epidermal destruction and allowing delivery of RF energy at varying depths into the dermis. Collagen destruction and collagen remodeling will follow and lead to positive results. Several devices for pin-type RF energy delivery are now available and we have reported on scanning technologies and newer delivery methods being successful in this regard.9,10 Fractional EBDs with microneedles and RF are also becoming very popular. Some of the devices in this category have insulated microneedles and some in this category have non-insulated microneedles to deliver their RF energy into the skin. From all published studies, it appears that both forms of microneedling, insulated and non-insulated, work well in treating wrinkles and lax skin, and both have shown positive effects in skin lifting as well.11,12 One must decide which modality works best for them – RF destruction at the tip of the needle or RF destruction along the course of the entire needle. Both penetrate the dermal-epidermal junction before delivering their RF energy, which is why post-inflammatory pigment changes are not very common with these modalities. Examples of RF fractional therapies are shown in Figures 4 and 5. Pigmentary concerns are some of the most common and problematic changes that we face daily in our clinical practices. EBDs have treated these conditions over the years with modest effects. In recent years, picosecond lasers have been introduced into the cosmetic armamentarium.These newer lasers not only treat tattoos faster and better than the traditional Q-switched
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