Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: A retrospective review

Haimovic, Adele; Brauer, Jeremy A.; Bae, Yoon-Soo Cindy; Geronemus, Roy G.

doi:10.1016/j.jaad.2015.12.010

Cited by 77 publications

(80 citation statements)

References 29 publications

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“…Fortunately most patients have MIs greater than 12 with superficial hemorrhage not being a problem. It has been well documented that the darker skin types do well with this type of wounding without the dyspigmentation as seen with other non-ablative devices [7].When considering the epidermal absorption of 532 nm, 1,064 nm, and 755 nm radiation we can see not only the effect of absorption of the first chromophore and melanin, Table 1 for specific parameters. Erythema was seen immediately after treatment with all wave lengths.…”

mentioning

confidence: 69%

A comparative study with a 755 nm picosecond Alexandrite laser with a diffractive lens array and a 532 nm/1064 nm Nd:YAG with a holographic optic

Tanghetti

Jennings

2017

Lasers Surg Med

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Background and Objectives: This study was performed to better understand the cutaneous effects of using a fractional picosecond laser at 755 nm with a diffractive lens array and a picosecond Nd:YAG laser at 532 mn and 1,064 nm with a holographic optic. We characterized the injuries created by these devices on skin clinically and histologically over 24 hours. With this information we modeled the effects of these devices on a cutaneous target. Methods: Eight patients, representing Fitzpatrick skin types I-VI, were treated on their backs with a picosecond Alexandrite laser with a diffractive lens array, as well as a picosecond Nd:YAG laser at 532 nm and 1,064 nm with a holographic optic. Photographs were taken 15 minutes and 24 hours after treatments. Punch biopsies were obtained at 24 hours and examined histologically. Results: Treatment with the picosecond Nd:YAG laser at both 532 nm and 1,064 nm with the holographic optic revealed erythema and small scatted areas of petechial hemorrhage areas immediately and in many cases at 24 hours after treatment. The 755 nm picosecond Alexandrite laser with diffractive lens array produced erythema immediately after treatment, which largely dissipated 24 hours later. Histologies revealed intra-epidermal vacuoles with all three wavelengths. Fractional picosecond Nd:YAG laser at 532 nm and 1064 nm with the holographic optic showed focal areas of dermal and intra-epidermal hemorrhage with areas of vascular damage in some patients. Conclusions: This study demonstrates that both fractional picosecond devices produce vacuoles in the skin, which are most likely due to areas of laser induced optical breakdown (LIOB). In the patients (skin type II-IV) we observed scatter areas of hemorrhage in the skin, due to vascular damage with the 532 nm and 1,064 nm, but not with 755 nm wavelengths. Lasers Surg. Med. 50:37-44, 2018. © 2017 Wiley Periodicals, Inc.Key words: laser induced optical breakdown (LIOB); superficial hemorrhage; fractional picosecond laser; holographic optic; diffractive lens array INTRODUCTIONThe use of picosecond lasers with fractional optics have provided an opportunity to deliver high energy short pulses of light to the skin. The picosecond Alexandrite 755 nm laser with a diffractive lens array has been used successfully to treat acne scars [1], photo-damaged skin [2], and melasma [3]. We have described the creation of intraepidermal vacuoles, which appear to be the result of areas of LIOBs from the absorption of high energy 755 nm laser light by melanin in the granular layer of the epidermis [4]. This localized damage has been associated with the production of new collagen and elastic tissue. It is possible that the production of epidermally generated growth factors, cytokines, and chemokines could be responsible for these changes [1,5]. The immediate clinical effects of transient erythema, heat, and swelling with this device lasting less than 24 hours has been well characterized [5]. In individuals with skin types I and II with melanin index (MI) of 12 or less we ha...

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confidence: 69%

A comparative study with a 755 nm picosecond Alexandrite laser with a diffractive lens array and a 532 nm/1064 nm Nd:YAG with a holographic optic

Tanghetti

Jennings

2017

Lasers Surg Med

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“…This gives the opportunity for safer and more effective treatment options for darker Fitzpatrick skin types without the significant risks of thermal diffusion to the surrounding tissues and possible post‐inflammatory hyperpigmentation (PIH) that nanosecond pulse durations can produce. There are numerous studies published to support this .…”

Section: Introductionmentioning

confidence: 84%

Using normal and high pulse coverage with picosecond laser treatment of wrinkles and acne scarring: Long term clinical observations

Dierickx¹

2017

Lasers Surg Med

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ObjectiveThe picosecond 755 nm alexandrite laser using a diffractive lens array has demonstrated consistent clinical efficacy for improving the appearance of acne scarring and wrinkles amongst other benefits. This small pilot study is to assess the difference, if any, in clinical benefit if a higher than the standard protocol for number of pulses delivered to a tissue area is used compared to the standard protocol guidelines.MethodSeven subjects received treatment to one side of the face with a standard protocol number of laser pulses with the other side of the face receiving higher than standard number of pulses from the same 755 nm picosecond laser using an additional diffractive lens array. Photographs at final follow up were compared to baseline by two blinded Board Certified Dermatologists and assessed for improvements to acne scarring using a 6‐point grading score, for wrinkles using the Fitzpatrick Wrinkle & Elastosis 3‐point grading scale and a Global Aesthetic Improvement Scale assessment. Subjects also completed a satisfaction questionnaire.ResultsFor the acne scarring subjects, the average improvement from baseline to final follow up was 4.0 +/− 1.0 for the standard treated side and 4.5 +/− 0.5 for the high pulse side. There was no statistically significant difference between the two treated sides (P > 0.05, n = 3 paired t‐test). For the wrinkle subjects, the average grading of the standard pulse side improved from 2.0 +/− 0.82 to 1.75 +/− 1.0 from baseline to final follow‐up. The high pulse side improved from 1.5 +/− 1.0 to 1.125 +/− 0.25 from baseline to final follow‐up. There was no statistically significant difference between the improvement of the standard and high pulse treatment sides (P > 0.05, n = 4 paired t‐test). The comparison of baseline to final follow‐up images of each subject found both sides to be Much or Very Much improved with no statistically significant difference between the standard and high pulse sides (P > 0.05, n = 7 paired t‐test). Six of the seven subjects did not note any difference between the effect on different sides of the face and four of the seven rated their overall improvement after treatment as Good, three subjects as Reasonable and one subject with Slight Improvement. All subjects found the treatment comfortable and easy to tolerate and there was no increased incidence of side effects other than the mild occurrences typically observed for this type of treatment.ConclusionThis is a small pilot study with limited subject numbers and further data is needed to be able to make firm conclusions of observed trends, which suggest that the use of higher than standard suggested protocol number of pulses with the diffractive lens array and the 755 nm picosecond laser does not appear to offer any additional benefit over that that can already be achieved with the standard number of pulses, but also does not increase risk of detrimental post treatment effects either. Lasers Surg. Med. 50:51–55, 2018. © 2017 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodic...

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“…[79][80][81] Fractionated picosecond handpieces have been developed for resurfacing and rejuvenation, including the 755-nm picosecond alexandrite laser PicoSure (Cynosure, Westford, MA), which contains a diffractive lens array (DLA) and the dual-wavelength 532/1064-nm holographic fractionated picosecond laser, PicoWay Resolve (Syneron Candela, Irvine, CA). The PicoSure with DLA received US Food and Drug Administration (FDA) approval in 2014 to treat acne scarring and rhytides, 81 while the PicoWay received FDA approval in 2014 to treat all tattoo colors. The DLA delivers high-energy pulses 500 μm apart, which allows for the treatment of a larger surface area and a higher density per pulse.…”

Section: Picosecond Lasersmentioning

confidence: 99%

“…Less than 10% of the skin surface is exposed to the higher energies, and the total fluence remains low, creating a favorable safety profile. 81 Microscopically, this modality leads to localized epidermal vacuoles with no collateral thermal damage, which then eventuates increased dermal collagen and elastin fibers. 82,83 Thus far, only a small number of studies have been conducted on these lasers.…”

Section: Picosecond Lasersmentioning

confidence: 99%

“…80 Transient adverse effects include edema, erythema, crusting, scabbing, and hyperpigmentation, with most resolving within a few days. 81,83,84 Combined fractional resurfacing One of the latest advancements in fractional lasers is an HFL, combining both ablative and nonablative technologies. In a single treatment spot, the Halo (Sciton, Palo Alto, CA) can provide ablation of the epidermis up to 100 μm by using the 2940-nm Er:YAG as well as nonablative coagulative damage to the epidermis and dermis from 100 to 700 μm by using the 1470-nm diode.…”

Section: Picosecond Lasersmentioning

confidence: 99%

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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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Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: A retrospective review

Cited by 77 publications

References 29 publications

A comparative study with a 755 nm picosecond Alexandrite laser with a diffractive lens array and a 532 nm/1064 nm Nd:YAG with a holographic optic

A comparative study with a 755 nm picosecond Alexandrite laser with a diffractive lens array and a 532 nm/1064 nm Nd:YAG with a holographic optic

Using normal and high pulse coverage with picosecond laser treatment of wrinkles and acne scarring: Long term clinical observations

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

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