Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy

Bencini, Pier Luca; Tourlaki, Athanasia; Galimberti, M.; Longo, Caterina; Pellacani, Giovanni; Giorgi, Vincenzo De; Guerriero, Giuseppe

doi:10.1111/j.1529-8019.2012.01478.x

Cited by 47 publications

(39 citation statements)

References 15 publications

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“…A large study of 87 Italian patients (skin types I-V) revealed a greater than 50% improvement in atrophic scars in 89% of patients after 3 months and in 92% of patients after 6 months. 52 Similar studies in Asian patients corroborate these results. 53 The Er:glass has been shown to perform best on boxcar scars (52.9% improvement), followed by rolling (43.1% improvement) and ice-pick scars (25.9% improvement).…”

Section: Acne Scarringsupporting

confidence: 61%

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

2017

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I n recent decades, there has been a revolution in energy-based treatment options for skin scarring, rejuvenation, and tightening. One of the most promising developments has been the introduction of fractional photothermolysis, developed by Anderson and Manstein in 2004. Fractionated systems deliver laser energy in a grid-like pattern, creating microscopic columns of ablative and/or coagulative damage termed microthermal zones (MTZs), which stimulate collagen remodeling.1 The incorporation of fractional photothermolysis into energy-based devices has allowed less destruction to surrounding tissue, leading to desired results with the minimization of unwanted side effects, leading to both ablative and nonablative laser devices becoming desirable treatment options for cutaneous scarring and rejuvenation. Given their impressive results, newer fractional laser treatment options, including picosecond lasers, quality-switched (QS) lasers, and combined ablative and nonablative lasers, are being investigated for the treatment of these common skin conditions.The following review addresses the current and emerging topics on fractional laser treatment of skin scarring and rejuvenation based on the device type, including ablative, nonablative, QS, picosecond, and hybrid fractional lasers (HFLs). Additionally, newer energy-based fractional devices, such as radiofrequency (RF) with and without microneedling and the use of fractionated technology for drug delivery, are discussed in the context of these common skin conditions. Fractionated lasersTreatment options for cutaneous scars and skin rejuvenation have evolved significantly since the rise in popularity of ablative lasers in the 1990s. Newer treatment options, including ablative fractional lasers (AFL) and nonablative fractional lasers (NAFL), have garnered favor, given the milder side effect profile in comparison with traditional fully ablative lasers. Ablative fractional lasersAcne scarring AFLs were developed in an attempt to achieve the efficacy of traditional ablative lasers with the milder side effect profile of fractional technology. Although a single treatment produces less dramatic, albeit noticeable, results than traditional fully ablative lasers can, multiple treatments result in greater clinical improvement.2 Currently, there are 3 types of AFLs available for scar treatment: the 10600-nm carbon dioxide (CO2), the 2940-nm erbium:yttrium aluminum garnet (Er:YAG), and the 2740-nm yttrium scandium gallium garnet (YSGG) lasers. AFL is associated with the increased risk of both protracted erythema and postinflammatory hyperpigmentation (PIH) in darker skin types, which has led many clinicians to prefer a longer series of NAFL treatments over AFL treatments to achieve similar results with a lower risk of side effects.Multiple studies support the efficacy of the fractional CO2 laser in acne scars. The overwhelming majority of these studies investigate the utility of these lasers in atrophic facial scars. While NAFLs typically require multiple sessions to achieve modest ...

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Section: Acne Scarringsupporting

confidence: 61%

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

2017

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“…Epidermal changes and collagen remodeling were evaluated by in vivo confocal microscopy [22]. Recently, Sattler et al treated healthy probands with fractional carbon dioxide laser; then the optical follow-ups were performed using confocal laser scanning microscopy and optical coherence tomography right after laser application and during the following 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

Effects of the Combined PDL/Nd:YAG Laser on Surgical Scars: Vascularity and Collagen Changes Evaluated byIn VivoConfocal Microscopy

Vas

Gaál

Varga

et al. 2014

BioMed Research International

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The aim of this study was to investigate the efficacy of the sequential combined 585 nm PDL and the 1064 nm neodymium:yttrium-aluminium-garnet laser (PDL/Nd:YAG) in the treatment of surgical scars and to evaluate the short-term effects by in vivo confocal microscopy (RCM) and the long-term effects by clinical assessment of the scars. Twenty-five patients were enrolled with 39 postoperative linear scars; each scar was divided into two fields. One half was treated with the combined PDL/Nd:YAG laser, whereas the other half remained untreated. Each scar was treated three times at monthly intervals. Scars were evaluated by an independent examiner, using the Vancouver Scar Scale. The combined PDL/Nd:YAG laser significantly improved the appearance of the scars. In order to study the short-term effects of combined laser treatment, six additional patients were enrolled with 7 postoperative linear scars. One half of scars was treated once with the combined PDL/Nd:YAG laser. One week after this laser treatment, both the treated and the nontreated parts of the scars were examined by dermoscopy and RCM. The dermoscopic pictures revealed improvements even in treated areas. In conclusion, the combined PDL/Nd:YAG laser was found to be effective in improving the quality and appearance of the surgical scars.

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“…Several retrospective and randomized controlled trials of acne scar treatment 14,15 have shown long-term improvement in skin texture after nonablative fractional photothermolysis. Nonablative fractional lasers produce long-term collagen remodeling in burn scars and surgical scars.…”

Section: Evidence For Skin Tightening With Nonablative Fractional Phomentioning

confidence: 99%

Fractional Nonablative Laser Resurfacing

Kauvar¹

2014

Dermatologic Surgery

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Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy

Cited by 47 publications

References 15 publications

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

Effects of the Combined PDL/Nd:YAG Laser on Surgical Scars: Vascularity and Collagen Changes Evaluated byIn VivoConfocal Microscopy

Fractional Nonablative Laser Resurfacing

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