The histology of skin treated with a picosecond alexandrite laser and a fractional lens array

Tanghetti, Emil

doi:10.1002/lsm.22540

Cited by 130 publications

(209 citation statements)

References 8 publications

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“…At 1 week and later time points, microscopic epidermal necrotic debris, MEND, areas, consistent with previous histologic observation , were imaged across the treated epidermis, located mainly in the top layers, beneath the stratum corneum. The term MEND was initially used to describe damage associated with non‐ablative fractional resurfacing lasers but it can be applied as well to the damage observed with the fractioned picosecond devices .…”

Section: Discussionsupporting

confidence: 84%

“…After 24 hours and at later time points, inflammatory cells were imaged in the proximity of damaged cells and MEND areas. In Tanghetti's recent study, histological findings indicated mild to moderate lymphocytic perivascular inflammation in the papillary dermis, but not in the epidermis .…”

Section: Discussionmentioning

confidence: 89%

“…These differences might be explained by the engineering characteristics of the optical element used to generate the laser micro‐injury pattern. While the fractionated pattern of the treatment laser was achieved through 2‐D scanning of the focused laser beam in the study by Habbema et al , a diffractive microlens array and a holographic beam‐splitter were used for the lasers in the study by Tanghetti , and in this work, respectively. Yet, it is noteworthy that both 532 and 1064 nm PicoWay wavelengths generated micro‐injuries in the epidermis only, with the LIOB mechanism being triggered by the laser light absorption of melanin.…”

Section: Discussionmentioning

confidence: 99%

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In vivo multiphoton‐microscopy of picosecond‐laser‐induced optical breakdown in human skin

et al. 2017

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Importance Improvements in skin appearance resulting from treatment with fractionated picosecond-lasers have been noted, but optimizing the treatment efficacy depends on a thorough understanding of the specific skin response. The development of non-invasive laser imaging techniques in conjunction with laser therapy can potentially provide feedback for guidance and optimizing clinical outcome. Objective The purpose of this study was to demonstrate the capability of multiphoton microscopy (MPM), a high-resolution, label-free imaging technique, to characterize in-vivo the skin response to a fractionated non-ablative picosecond-laser treatment. Design, Setting and Participants Two areas on the arm of a volunteer were treated with a fractionated picosecond laser at the Dermatology Clinic, UC Irvine. The skin response to treatment was imaged in-vivo with a clinical MPM-based tomograph at 3h and 24h after treatment and 7 additional time points over a 4-week period. Main Outcomes and Measures MPM revealed micro-injuries present in the epidermis. Pigmented cells were particularly damaged in the process, suggesting that melanin is likely the main absorber for laser induced optical breakdown. Results Damaged individual cells were distinguished as early as 3h post pico-laser treatment with the 532nm wavelength, and 24h post treatment with both 532nm and 1064nm wavelengths. At later time points, clusters of cellular necrotic debris were imaged across the treated epidermis. After 24h of treatment, inflammatory cells were imaged in the proximity of epidermal micro-injuries. The epidermal injuries were exfoliated over a 4-week period. Conclusions and Relevance This observational and descriptive pilot study demonstrates that in-vivo MPM imaging can be used non-invasively to provide label-free contrast for describing changes in human skin following a fractionated non-ablative laser treatment. The results presented in this study represent the groundwork for future longitudinal investigations on an expanded number of subjects to understand the response to treatment in different skin types with different laser parameters, critical factors in optimizing treatment outcome.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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In vivo multiphoton‐microscopy of picosecond‐laser‐induced optical breakdown in human skin

et al. 2017

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“…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. The PicoSure has been shown to improve the appearance and texture of atrophic facial acne scars, with similar efficacy to other fractional lasers.…”

Section: Picosecond Lasersmentioning

confidence: 99%

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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“…This allows an effective treatment at lower fluences, thereby decreasing the thermal energy transferred to surrounding tissues. In pigmented lesions, the mechanism of action is predominantly the fragmentation of melanosomes and the scattering of the melanin particles [36] . Friedman treated 29 melasma patients of skin types II-IV, who were unsuccessfully treated with topical agents, with a large spot 532-nm Nd:YAG picosecond-domain laser.…”

Section: Picosecond Lasersmentioning

confidence: 99%

Energy-based devices for treatment of melasma

Jordão

Rebellato

2017

J Surg Dermatol

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Melasma, as a pigmentation disorder, induces significant stress to the patients and its recurrent nature remains a challenge in clinical practice. Treatment is based on a variety of mechanisms to prevent and/or stop the pigment production process by destroying the deposited pigment for removal or release, by peeling cells to improve their turnover, and by reducing inflammation. The use of appropriate devices and correct settings are crucial in the treatment of melasma. Cases unresponsive to topical bleaches or chemical peels should be referred for laser therapy. It is important that a maintenance therapy to avoid the recurrence of melasma be indicated. In this paper, we review energy-based devices for melasma treatment.

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The histology of skin treated with a picosecond alexandrite laser and a fractional lens array

Cited by 130 publications

References 8 publications

In vivo multiphoton‐microscopy of picosecond‐laser‐induced optical breakdown in human skin

In vivo multiphoton‐microscopy of picosecond‐laser‐induced optical breakdown in human skin

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

Energy-based devices for treatment of melasma

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