Split-Face Comparison of Ultrapulse-Mode and Superpulse- Mode Fractionated Carbon Dioxide Lasers on Photoaged Skin

November 2012 | Volume 11 | Issue 11 | Original Article | 1310 | Copyright © November 2012


Yao-Jia Luo MD,a Xue-Gang Xu MD,a Yan Wu PhD,a Tian-Hua Xu PhD,a John Z. S. Chen PhD,b Xing-Hua Gao PhD,a Hong-Duo Chen MD,a and Yuan-Hong Li PhDa

aDepartment of Dermatology, No.1 Hospital of China Medical University, Shenyang, Liaoning, China bSheftel Associates Dermatology, Tucson, AZ

Abstract

Background: Both ultrapulse-mode and superpulse-mode fractional CO2 lasers (UPCO2 and SPCO2) could be successfully used in treating photoaged skin.
Objective: This evidence-based study was intended to compare the therapeutic and adverse effects of UPCO2 and SPCO2 in treating photoaged skin in Chinese subjects.
Methods: Eighteen Chinese subjects with Fitzpatrick skin type IV were enrolled in a randomized, split-face trial. Subjects received SPCO2 on one half of the face and UPCO2 on the other half. Before and after photos, skin color, epidermal water content, sebum level, periorbital wrinkles, skin roughness, and self-esteem questionnaires were used.
Results: Global evaluation and subjects' self-esteem assessments showed a similar trend at 1-month and 3-month follow-up visits on both sides. The UPCO2 laser has a shorter downtime of 6.25±2.71 days compared with 6.41±2.67 days for SPCO2, but has a higher incidence of edema, spot bleeding, prolonged redness and postinflammatory hyperpigmentation. More subjects prefer SPCO2 treatment because of similar efficacy and fewer adverse effects.
Conclusion: The effectiveness of the SPCO2 laser in treating photoaged skin is very similar to the UPCO2 laser, with less erythema, but more crusting and longer downtime.


J Drugs Dermatol. 2012;11(11):1310-1314

INTRODUCTION

Ablative skin resurfacing (ASR) provides significant improvement in reversing signs of cutaneous photoaged skin1-6 but is limited by adverse postoperative sequelae such as extended recovery times, risk of infection, scarring, and persistent pigmentary changes.7,8 In contrast to ASR, which aims to achieve homogeneous thermal damage at a particular depth within the skin,9 ablative fractional photothermolysis produces arrays of microscopic thermal zones, creating small columns of thermal injury without injuring surrounding tissue. 10 This fractionated skin injury leaves small bridges of normal skin intact, which is thought to act as a natural bandage promoting reepithelialization within less than 48 hours with no loss of epithermal barrier function.1,11-13
Ultrapulse-mode fractional carbon dioxide (UPCO2) and superpulse- mode fractional carbon dioxide (SPCO2) are 2 commonly used modes in treating photoaged skin. Theoretically, UPCO2 delivers a "flat-top" pulse beam, with a higher fluence and shorter pulse duration, while SPCO2 delivers a stack of superpulse-shaped beams, which at the beginning of the pulse, produce a burst of energy that tails off throughout the duration of the pulse.14 Although the peak fluence of SPCO2 is only one third of UPCO2, the pulse duration is 3 times longer. It is postulated that the longer dwelling time compensates for the insufficiency of the pulse energy so that epidermal ablation can occur. We designed a split-face study to compare the efficacy and side effects of UPCO2 and SPCO2 in treating photoaged skin in Chinese subjects.

PATIENTS AND METHODS

Subjects

Eighteen female Chinese subjects (mean ± standard deviation age, 50±5.03 years; Fitzpatrick skin type IV) with obvious photoaged skin manifested as fine rhytids, irregular pigmentation, wrinkles, and skin laxity were enrolled from November 2009 to February 2010.15 The exclusion criteria were patients with concomitant treatments, pregnancy, skin cancer, a history of keloid, vitiligo, recurrent facial herpes simplex infection, diabetes, coagulation malfunction, infectious lesions, recent extensive sun exposure, and oral administration of photosensitive drugs.16 The study was approved by the Medical Ethics and Human Research Committee of China Medical University. All patients were informed of the risks, benefits, and possible complications of the treatment before enrollment into the study. Informed consent was obtained from each patient.

Equipment

The UPCO2 treatment was performed with the DeepFXTM handpiece of the UltraPulse CO2 fractionated laser (Lumenis Inc,
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