LASER Applications for Skin Rejuvenation

1. LASER Applications for Skin Rejuvenation Dr. Tzermias Christopher Athens Greece

2. LASER Applications for Skin Rejuvenation Traditional rejuvenation techniques (CO2, Er:YAG) characterized by top–to–bottom injuries, sacrifice epidermis to achieve subsequent dermal remodeling.

3. Ablative LASERs Produce: Epidermal Ablation: • Improvement in skin surface texture and dyspigmentation but • Prolonged healing time • High incidence of complications Dermal Injury Thermal Contraction: • Immediate collagen denaturation and shrinkage • Collagen remodeling • Wrinkle improvement

4. Ablative LASERs for Skin Rejuvenation • The primary mechanism for wrinkle reduction after laser resurfasing appears to be a dermal wound and new collagen formation. Therefore, is epidermal ablation really necessary for skin rejuvenation? • Theoretically, techniques that induce a dermal wound should lead to cosmetic improvement.

5. Non – Ablative LASERs For Skin Rejuvenation “Selective dermal remodeling” theoretically can be accomplished by: Deeply penetrating laser beam • Dermal Heating • New Collagen Production • Cosmetic Enhancement Surface – Cooling Device • Epidermal Preservation

6. Non – Ablative “Subsurface Remodeling” has been reported to be induced by: Pulsed – Dye Laser (P.Bjerriug et al, J. Cutaneous laser therapy,2000,2:9-15) 1320 nm - Nd : Yag Laser (D.J. Goldberg, Dermatol. Surg. 2000, 26 : 915-918) 1450 nm - Diode Laser (D.J. Goldberg, Lasers in Syrg and Med, 2000, 26:196-200) Intense Pulsed Light (D.J. Goldberg, K.B. Culter, Lasers in Surg. And Med, 2000,26:196-200)

7. Non- Ablative LASER for Skin Rejuvenation Pulsed-Dye Laser • Wavelength 585 nm selectively targets hemoglobin and melanin • Pulse duration: 0,35 millisecond (shorter than traditional 0,45 msec 585 PDLaser) • Low fluence range: 2-4 J/cm2 in order to insult but not injure the microrasculacture.

8. Pulsed – Dye Laser Histologic Evaluation Statistically significant increase in the production of type III procollagen. Hypothesis: Endothelial cells insulted by laser, release inflammatory mediators that trigger fibroblasts. Clinical Evaluation • Lack of purpura, no side effects • Statistically significant wrinkle improvement greater in Class II and III.

9. Non- Ablative LASER for Skin Rejuvenation 1320 nm Nd:Yag LASER • Wavelength with significant scattering properties. • Approximately 20-millisecond macropulse (train of three 300-microsecond pulses) • Coupled with a cryogen – spray cooling system of epidermis • Thermal sensor built into the handpiece to accurately document the temprature rise after pulse and aid the physician in choosing an optimal treatment fluence.

10. 1320 nm Nd :Yag LASER Histologic evaluation New collagen formation in all subjects at 6 months after the fourth treatment Clinical Evaluation • In general terms, mild clinical improvement and in few subjects lack of improvement • Histologic changes are not necessarily correlate with wrinkle reduction • Absence or minimal side effects.

11. 1450 nm Diode Laser • Tissue scattering properties similar to 1320nm Nd: Yag • Low-power system: longer exposures (150-250msecs) are required to achieve sufficient fluences for selective dermal heating • Dynamic Cooling Device: (pre–, intermediate-, and post-laser cryogen cooling) • Clinical Endpoint: Small edematous papules vs 1320 nm Nd :Yag post treatment erythema. • Clinical Evaluation: Subjective and objective wrinkle improvement seem to be modest and comparable to 1320 nm Nd :Yag laser.

12. Advantages of Non – Ablative LASERs • Absence of post - operative healing period: Ideal for the working individual • Minimal adverse effects • Helpful in maintaining the rejuvenating effect of ablative laser systems • Adjuctive method to laser treatment for face telangiectasia and age spots • No need for anesthesia • No need for post - operative topical agent administration.

13. Disadvantages Of Non – Ablative LASERs • Definately more subtle wrinkle improvement than those seen with ablative laser. • Delayed clinical improvement. (subsequent collagen deposition occurs orer a period of several months) • Microscopic changes are not always associated with cosmetic enhancement. • Abseuce of improvement in skin surface texture and dyspigmentation (midinfrared lasers) • Multiple treatment sessions • Higher cost than other resurfacing modalities that also provide mild improvement such as microdermabrasion and superficial chemical peels.

14. LASERLINE CLINICS“Non –Ablative LASERs and complementary techniques for skin rejuvenation”C. Tzermias, C. Gintzou, T. Anthopoulos • Objective: Clinical evaluation of wrinkle improvement and patient satisfaction using non- ablative lasers alone and in combination with microdermabrasion for skin rejuvenation • Material: Total cases: 50 / Age range 35-60 years Skin types: I – III / Solar and age – related wrinkles

15. Methods • All subjects were treated 3 times over a period of • 12-14 weeks with non- ablative midinfrared lasers: • 1450 nm Diode laser • Fluence range: 10-14 J/Cm2 • 1320 nm Nd :Yag laser • Fluence range: 28-36 J/Cm2 • Half of subjects were simultaneously submitted to seven microdernabration facial treatments at 15 days internal • Clinical and photographic assessments were recorded monthly • Final evaluation: one month after the third laser treatment

16. “Non–Ablative LASERs and complementary techniques for skin rejuvenation” Results • Neither 1450nm Diode nor 1320nm Nd :Yag laser induced statistically significant macroscopic wrinkle improvement. • Similar disappointing rates of clinical wrinkle improvement in both groups: Group A: Non-Ablative laser treatment alone Group B: Non-Ablative laser combined with microdermabrasion.

17. Results • Considerably higher satisfaction score in group treated with non – ablative laser and microdermabration • We propose the use of a complementary minimally aggressive technique such as microdermabrasion in order to restore a youthful appearance to the epidermis and increase patient satisfaction.

18. In conclusion • Non – ablative lasers is a safe treatment, suitable for patients with realistic expectations and who are unwilling or unable to undergo an ablative skin resurfacing laser procedure. • In combination with microdermabration can achieve non-invasively an overall skin improvement (clearer, smoother, brighter, younger-appearing). • Complementary method to vascular and pigmented laser treatments.