ARTICLE: The 1440 nm and 1927 nm Nonablative Fractional Diode Laser: Current Trends and Future Directions
August 2020 | Volume 19 | Issue 8 | Supplement Individual Articles | s3 | Copyright © August 2020
Published online August 1, 2020
Paul M. Friedman , Kristel D. Polder , Pooja Sodha , Roy G. Geronemus
aDermatology and Laser Surgery Center, Houston, TX bLaser & Skin Surgery Center of New York and New York University Medical Center, New York, NY cDallas Center for Dermatology and Aesthetics, Dallas, TX dGeorge Washington University, Washington, DC
Clinical characteristics of skin exposed to ultraviolet and infrared radiation include dryness, dyschromia, laxity, roughness, sallowness, scaling, telangiectasia, and wrinkles. Fractional photothermolysis promotes skin remodeling by formation of new dermal collagen. The nonablative fractional diode laser (NFDL) system employs fractional photothermolysis to rejuvenate the skin, using 2 distinct handpieces for wavelengths of 1440 nm and 1927 nm. Fractional photothermolysis from nonablative fractional diode lasers facilitates delivery of small molecular-weight compounds, such as L-ascorbic acid, through the skin without compromising barrier function of the stratum corneum. Both handpieces of the NFDL system are effective for rejuvenation of photodamaged facial skin, providing clinical improvement in skin tone, skin texture, fine lines, and dyschromia and reducing the number of detectable skin pores. Application of the 1927 nm wavelength handpiece has shown clinical improvement of hyperpigmentation, melasma, and postinflammatory hyperpigmentation, which have been challenging to treat effectively with other laser devices. With a target chromophore of water, the infrared energy of the 1440 nm and 1927 nm NFDL system is appropriate for skin rejuvenation and treatment of dyschromia in skin of color, with a reduced risk of the adverse events observed with other nonablative and ablative fractional lasers. Clinical data have demonstrated that both the 1440 nm and 1927 nm wavelengths are effective, with high levels of patient satisfaction, transient side effects, and minimal patient downtime. J Drugs Dermatol.
Skin exposure to ultraviolet (UV)B and UVA light and infrared radiation contributes to photoaging.1 Irradiated skin is metabolically hyperactive with epidermal hyperplasia and neoplasia, increased production of elastic fibers and glycosaminoglycans, accelerated breakdown and synthesis of collagen, and proinflammatory processes.1 Historically, skin rejuvenation of photoaged skin has involved invasive procedures.2 Over time, demand has grown for less invasive treatments and reduced patient recovery time.2,3 Moreover, procedures catering to all skin types are becoming increasingly popular. Mainstays include topical treatments such as retinoids, hydroquinone, and antioxidants. Nonablative fractional lasers for facial rejuvenation use midinfrared wavelengths ranging from 1320 nm to 1927 nm, which target water as a chromophore and preserve the corneal barrier. Treatment with a nonablative fractional laser may be performed in a clinical setting by a healthcare provider or, for some devices approved for patient use, at home.4 Advantages of nonablative fractional lasers include rapid skin healing, as well as reduced risk of dyschromia, scarring, and infection.2
A nonablative fractional diode laser (NFDL) system with a 1440 nm wavelength handpiece (Clear + Brilliant® laser system, Solta Medical, Inc., Bothell, WA) was approved by the US Food and Drug Administration (FDA) in 2011 for general skin resurfacing. The 2.5 W 1440 nm wavelength handpiece has 3 fixed energy levels: low energy achieves a depth of 280 μm and 2% coverage (assuming 4 total passes across the treatment area); medium energy achieves a depth of 340 μm and 3.5% coverage; and high energy achieves a depth of 390 μm and 4.5% coverage. In 2012, the FDA approved the 1927 nm wavelength handpiece as an addition to this NFDL system (Clear + Brilliant Perméa®, Solta Medical, Inc., Bothell, WA). The 1 W 1927 nm wavelength handpiece has a fixed energy level (5 millijoule [mJ]/pulse) achieving a depth of 170 μm and a coverage of 2.5% (low), 3.75% (medium), or 5% (high), assuming 4 total passes. The Intelligent Optical Tracking® System (Solta Medical, Inc., Bothell, WA), a feature of both handpieces, ensures activation only when the handpiece scanner senses contact with skin, along with proper handpiece movement and velocity.
The 1927 nm wavelength handpiece of the NFDL system described above differs from another device, the 1550 nm erbium-doped and 1927 nm thulium laser system (Fraxel® Dual laser system, Solta Medical, Inc., Bothell, WA) in that the latter